2. What are the physiological changes in pregnancy?
Pregnancy Intrapartum Postpartum
Cardiac out
put
Increase by
40%
Increse by
15%in 1st stage
increases
50%in 2nd
stage
Increase by
80%in 1st hour
And then
decrease pver
24 hours
Stroke
volume
Increases Increases Decreases
Heart rate Increases by
10 to 20 beats
Increases Decrease to
pre-pregnancy
3. What are the types of heart diseases in pregnancy?
1. Congenital heart diseases
● ASD
● VSD
● TOF (corrected or uncorrected)
1. Acquired heart diseases
Rheumatic heart disease ( most commonly Mitral stenosis )
1. Ischeamic heart disease
2. Cardiac rhythm abnormalities
Eg: SVT
5 .Peripartum cardiomyopathy
4. What are the congenial heart diseases in pregnancy
● ASD
● VSD
● TOF
● Primary Pulmonary hypertension (Eisenmeinger syndrome)
● Cynotic heart d
Q. In which heart disease in pregnancy maternal morbidity increases?
Eisenmeinger syndrome and cyanotic heart disease.
6. Effects on fetus
● Abortion or miscarriage
● Preterm labor
● Fetal growth retardation
● Congenital heart disease in baby
inherit 9 to 14%
7. Screening for cardiovascular diseases.
In children at school by medical inspections.
Pre pregnancy Cardiac assessment .
Cardiac assessment during pregnancy at antenatal clinics.
8. How to find out the cardiovascular diseases in pregnancy
at antenatal clinics?
History :-
● Symptoms of cardiovascular diseases
● Aggravating factors /co-morbidities
● Symptoms of complications of heart disease
● History of childhood heart disease
● Family History of heart disease .
11. PROGNOSIS:-
● Nature of the lesion
● Functional capacity
● Quality of medical supervision during pregnancy, labor
and puerperium
● Corrective surgery.
12. CARPREG RISK SCORE:-
Four predictors of Cardiac events were identified.
● Poor functional class [NYHA class 3 and 4]
● Previous cardiovascular event's including heart failure transient ischeamic
attack ,stroke,arrhythmias .
● Left heart obstruction Mitral valve area <2cm²
● AV area <1.5cm² peak at ventricular outflow gradient > 30mm hg
● Left ventricular systolic dysfunction [ EF <40%].
13. General management:-
● Early diagnosis and evaluation of anatomical type
and functional grade
● To detect high risk factors and to prevent Cardiac
failure
● Multidisciplinary team approach and mandatory
hospital delivery
14. Therapeutic termination and indications for
Cardiac surgery:-
Absolute:-
● Primary HTN
● Eisenmenger syndrome
● Pulmonary veno occlusive
disease
● Cyanotic heart disease often
need MTP 40%
● Termination should be done
within 12 weeks of pregnancy.
Indications of Cardiac
surgery:-
● Failure of medical treatment for
1. Intolerable symptoms
2. Intractable Cardiac Failure.
15. What are the complications we should monitor:-
● LVH
● PULMONARY EDEMA
● CCF
● SYSTEMIC EMBOLISM
● CARDIAC ARRHYTHMIAS
● INFECTIVE ENDOCARDITIS
17. Mode of delivery in pregnancy with CVD:-
Mode of delivery doesn't depend on type of heart disease:-
Vaginal delivery preferred >caesarean section
Caesarean section preferred in :-
● Coarctation of aorta
● Aortic dissection or aneurysm
● Dilated aorta not >4 cms
● Sever symptomatic aortic stenosis
● Warfarin treatment within 2 weeks.
18. During labor:-
● Reassurance
● Propulsion
● Oxygen
● IV line avoid over hydration
● Antibiotics prophylaxis
● Pain relief epidural analgesia is preferred
● Monitor PR, BP, lung bases temperature etc..
● Assist 2nd stage when necessary
● Avoid ergometrine
● Active management of 3 rd stage of labour.
20. During post-partum period :-
● Breast feeding
● Monitor post-partum complications
● Contraception [provide according to WHO medical
Eligibility criteria.]
