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- 2. INTRODUCTION Cardiac diseases complicate 1% to 4% of pregnancies in women without pre existing cardiac abnormalities patients with pre existing cardiac lesion should be counselled in advance about the risk of pregnancy.
- 3. CARDIAC VASCULAR CHANGES DURING PREGNANCY Increased cardiac output 30-50% more than pre pregnant level. Increased stroke volume. Increased heart rate(10/mt) Expanding blood volume Decreased vascular resistance and BP. Functional systolic murmur. Upward displacement of diaphragm Accenturated breathing effort similar to dyspnoea. Lower extremity edema. Increased venous return with contractions subsequent increase an cardiac output. Increased mean arterial pressure during contraction.
- 4. CARDIAC DISEASES RHEUMATIC HEART DISEASE CONGENITAL HEART DISEASE MITRAL VALVE PROLAPSE BACTERIAL ENDOCARDITIS PERIPARTUM CARDIOMYOPATHY EISENMENGER’S SYNDROME
- 5. RHEUMATIC HEART DISEASE It is most common type of heart diseases seen in pregnancy resulting from the episode of rheumatic fever causing recurrent inflammation and valvular scaring. Mitral valve was affected with stenosis resulting in 90% of the cases. Recognition of the role of streptococcal infection and its appropriate therapy has greatly reduced the frequency of the consequences of Rheumatic fever.
- 6. CONGENITAL HEART DISEASES The most common disease found in pregnancy are ASD,VAD,PDA, Pulmonary stenosis, Aortic stenosis, Coarctation of Aorta & TEF. These clients have an assessment of defects and vary in their functional capacity during pregnancy. Women who have no symptoms and who do not have cyanotic heart diseases tolerate pregnancy. Older child bearing women may be at increased risk for these condition.
- 7. MITRAL VALVE PROLAPSE 6%-10% of women of child bearing age are affected. Prolapse of the mitral valve leaflets into left atrium during ventricular systole causing some backflow of blood. Most women were Asymptomatic and they are able to tolerate the pregnancy well.
- 8. BACTERIAL ENDOCARDITIS Inflammation of the inner lining of the heart usually involving the heart valves. Tricuspid valve is infected Parentral substance abusers represent a growing number of pregnant women at high risk for acquiring bacterial endocarditis. Offending organisms--- Staphylococcus aureus, streptococcus pneumonia. Symptoms– fever for 2 weeks, pleuritic chest pain, dyspnea, exertion, orthopnea and cardiac murmur.
- 9. PERIPARTUM CARDIO MYOPATHY Congestive failure with cardiomyopathy occurs between the last trimester of pregnancy and the 5 post partum months without obvious cause of cardiac disease. 25-50% with a significant murmur of deaths occurring shortly after the onset of the signs and symptoms. The main pathologic features are reduced left ventricular ejection fraction and impaired ventricular contractile power. Clinical manifestation include breathlessness, tachycardia, arrhythmias, cardiomegaly and edema
- 10. EISENMENGERS SYNDROME It develops when progressive pulmonary hypertension leads to shunt reversal in women with congenital left to right shunt. This syndrome is most likely to arise with VSD because high pressure and high flow associated with these defects. Decreased systemic vascular resistance associated with pregnancy increases the occurrence of right to left shunting causing decreased pulmonary perfusion and hypoxemia for the women and fetus.
- 11. EFFECT OF CARDIAC DISEASES ON PREGNANCY Increasing blood volume will precipitate congestive heart failure. Maternal blood flow is severely compromised. Diminish placental perfusion --- high risk of prematurity and LBW. Major problem in managing clients with artificial cardiac valves is coagulation.
- 12. CARDIAC DISEASES DURING PREGNANCY • MOTHER’S WITH CARDIAC DISEASES BUT NO LIMITATION OF PHYSICAL ACTIVITYGRADE I UNCOMLICATED • MOTHER’S WITH CARDIAC DISEASES WITH SLIGHT LIMITATION OF PHYSICAL ACTIVITY.MOTHERS ARE COMFORTABKLE AT BED REST BUT ORDINARY PHYSICAL ACTIVITY CAUSES DISCOMFORT GRADEII SLIGHTLY COMPROMISED • MOTHER’S WITH CARDIAC DISEASES WITH MARKED LIMITATION OF ACTIVITY.THEY ARE COMFORTABLE AT REST, BUT DISCOMFORT OCCURS WITH LESS THAN ORDINARY ACTIVITY. GRADEIII MARKEDLY COMPROMISED • MOTHER HAVE DISCOMFORT EVEN AT REST GRADE IV SEVERELY COMPROMISED
- 13. SIGNS AND SYMPTOMS OF CARDIAC DECOMENSATION Dyspnoea Palpitation Chest pain Cough Pulse irregularity Sweating Orthopnoea Weakness Progressive generalized edema Rales at the base of the lungs. Pallor
- 14. DIAGNOSTIC EVALUATION Complete blood count ECG Chest radiograph to assess cardiac size, outline , pulmonary vasculature and lung fields. Clotting studies. Chest X- ray are considered safe in pregnancy and should always be performed in un well pregnant women with chest pain. Clotting studies. Echocardiography.
- 15. MANAGEMENT PRECONCEPTION CARE: Women with known heart diseases should seek advice from the cardiologist and obstetrician before becoming pregnant. General health advice can be given by a midwife with regard to diet, weight, exercise, rest and prevention of anemia, avoidance of tobacco drugs alcohol.
- 16. PHYSICAL AND PSYCHOLOGICAL CARE All women with heart diseases will require additional rest during pregnancy. In late pregnancy women may require admission to hospital for rest and close monitoring. Psychological support is given to the mother.
- 17. STRESS, REST AND ACTIVITY Minimum of 10 hours of sleep per night and additional morning and afternoon rest period . Limit the activity. Complete bedrest in the second half of pregnancy. Custom-fitted support stockings sre beneficial to all cardiac clients in later half of the pregnancy. Reduce the hemodynamic fluctuation that accompany changes in maternal posture and increases venous return by improving muscle function.
- 18. PREVENTION OF INFECTION Febrile episodes increased cardiac demands are often associated with tachycardia. Spread of the infectious organism may cause direct damage to the heart. Encourage early dental examination and dental carries.
- 19. PREVENTION OF INFECTION Infection often cause pyrexia and tachycardia which will increase cardiac output and put on added strain on the heart. An early dental examination is important to detect and treat dental carries and gum disease which will precipitate endocarditis. Prophylactic antibiotic therapy. All invasive procedure should be performed in strict aseptic techniques. Minimise the number of vaginal examination. Proper perineal care should be emphasized and preventing UTI and pyelonephritis.
- 20. MEDICATION Women who receiving digitalis prior to pregnancy must continue use of drug throughout the pregnancy and child bearing cycle. Maternal HR and FHR should be slowed by digitalis which cross the placental barrier. If Arrythmias develop during pregnancy cardio version may be accomplished safely with Quinidine. Diuretic therapy is generally not recommended for class I and class II women during pregnancy but may it may be prescribed class III class IV Thiazides such as Chlorthiazide, hydrochlorthiazide are commonly prescribed diuretics. The women on diuretic therapy should be observed for potassium depletion and postural hypotension. Neonatal thrombocytopenia, electrolyte imbalance SGA infants have been observed whose others used Thiazide diuretics in pregnancy.
- 21. The drug is administered in two or three subcutaneous boluses or through an infusion pump. Antibiotic therapy such as penicillin and cephalosporine cross the placenta and are well tolerated by the fetus. It is recommended for women with bacterial endocarditis. Just prior to delivery, some physician prescribes prophylactic abtibiotic for women with valvular heart diseases and congenital defects because of their high susceptibility to sub acute bacterial endocaritis
- 22. CARE OF POST NATAL MOTHERS Special consideration given to the possible need for limited activity and additional rest. Stoll softeners may be prescribed to prevent straining on defecation. Discharge planning New-born care.