Obestrics topic cardiovascular disease

1. Pregnancy and
cardiovascular diseases

2. Cardiovascular disease (CVD) in pregnant women
ranks first among all extragenital diseases

3. During pregnancy, increased stress on the
cardiovascular system causes physiologic changes in
hemodynamics and cardiac function

4. congenital acquired

5.  Acquired heart defects (AHD) are acquired
anomalies of the heart valves, openings or partitions
between heart chambers and (or) large vessels
branching from it.
 Acquired rheumatic heart defects account for 75% to
90% of heart defects in pregnant women

6. According to the nature of the lesion of the valve
apparatus:stenosis and insufficiency
Depending on the location of the lesion of the valve
apparatus:
 mitral valve
 aortic valve
 pulmonary valve
 tricuspid valve

7. Depending on the involvement of other heart
valves are distinguished:
 isolated malformations - one valvecombined
 malformations - several valves
 Combined malformations - combination of lesions
of one valve

8. ETHIOLOGY
rheumatic heart
disease
non-rheumatic heart
disease
- infective
endocarditis;
-atherosclerosis;
-syphilis;
-systemic lupus
erythematosus;
-scleroderma.

9.  mitral stenosis is the most common form of
rheumatic heart disease
 The second most common malformation (6-7%) is
mitral valve insufficiency. As a rule, in this
malformation, in the absence of significant
regurgitation of heart rhythm disturbances and
circulatory insufficiency, pregnancy does not
significantly worsen the course of heart disease

10. The main complaints of heart defects are:
 rapid fatigue
 muscle weakness
 leg heaviness
 drowsiness
 Heart palpitations and shortness of breath,
occurring only with exertion, as the disease
progresses dyspnea is also observed at rest

12.  electrocardiography - registration of electrical phenomena
occurring in the heart muscle during its excitation
 vectorcardiography - detection of signs of hypertrophy of
heart sections
 phonocardiography - a method of recording sounds (tones
and noises) arising from the heart activity, and used to
assess its work and recognize disorders, including valve
defects
 Echocardiography - determination of hemodynamics and
cardiodynamics, determining the size and volume of heart
cavities, assessing the functional state of the myocardium.
The method is harmless to the mother and fetus

13.  rheography - to determine the state of
vascular tone, elasticity, blood flow in
pregnancy
 stress tests - to assess the functional state of
the myocardium.
 external respiratory function studies

15.  Reducing the risk of complications of
pregnancy and childbirth in pregnant women
 Treatment of exacerbations or relapses of
rheumatic fever (antibiotic therapy)
 Prevention and treatment of rhythm and
conduction disorders

16. Non-medicament treatment
1. therapeutic regime, diets (table № 10
according to Pevzner) with restriction
of table salt
2. in case of venous return disorders -
wearing elastic stockings
drug treatmentdrug therapy is
prescribed cardiologist individually

17. The need, timing and methods of surgical
correction of PPS are determined by the cardiac
surgeon.
Surgical correction of valve lesions is considered a
radical method of treatment of patients with PPS
and is performed during pregnancy when the
condition worsens.
The optimal time for surgical for surgical
correction of the malformation at the stage
prenatal preparation

18. Main measures:
- diet with sufficient proteins, vitamins and
microelements;
- limitation of salt and fluid intake;
- prevention of infectious diseases of the
respiratory and urinary tract;
- normalization of work and rest, limitation of
physical exertion;
- prescription of phytopreparations with sedative
effect

19. CONGENITAL
MALFORMATIONS OF THE
HEART AND MAIN
VESSELS IN PREGNANT
WOMEN

20. occurrence (9-17%). It is more often manifested clinically in 30-
40 years of age.
 course and outcome of pregnancy with this heart defect
usually favorable
 in rare cases with increasing heart failure insufficiency is
indicated surgical treatment

21.  Rare
 often combined with aortic valve insufficiency
 Pregnancy is usually uncomplicated.
 Paradoxical systemic embolism may occur after
delivery

22.  If the duct is not closed, blood is discharged
from the aorta into the pulmonary artery →
dilatation of the pulmonary artery, left atrium
and left ventricle
 Complications: Pulmonary hypertension,
bacterial endocarditis, heart failure

23.  the most common congenital malformation (8-10%)
 Complication: right ventricular insufficiency, as
pregnancy increases circulating blood volume and
cardiac output
 with mild to moderate pulmonary artery stenosis
pregnancy and labor can proceed safely

24.  pulmonary trunk orifice stenosis
 large ventricular septal defect
 aortic dextroposition
 right ventricular hypertrophy
women who have undergone radical surgery women who have
undergone radical surgery for this malformation have a better chance of a
favorable course of pregnancy and childbirth

25.  subvalvular (congenital and acquired),
 valve (congenital and
acquired)supravalvular
 In women with slight or moderate
congenital stenosis of the aorta,
pregnancy proceeds without
complications

26.  narrowing of the aorta in the area of its isthmus
(border of the arch and descending part of the
aorta).
Complications:
 hemorrhage into the brain,
 dissection or rupture of the aorta,
 subacute bacterial endocarditis.
Death is not uncommon.

27. 

28. at least 3 hospitalizations
in the 1st trimester to the cardiology department to clarify
the heart defect and decide on prolongation of pregnancy

29. at 20-24 weeks of pregnancy to a specialized
department (cardiology or cardiac surgery)
Purpose: corrective treatment (surgical treatment),
prevention of complications

30. at 37-38 weeks to decide on the term and
choice of delivery method

31. signs of circulatory insufficiency,
exacerbation of rheumatism, atrial
fibrillation, late pregnancy gestosis or
severe anemia..

32. In case of ineffective treatment, the
presence of contraindications to
surgical intervention on the heart decide
to terminate pregnancy (with the
consent of the woman).

33. Pregnancy is usually complicated by:severe
preeclampsia (from the 2nd half of pregnancy)
chronic DIC
Placental insufficiency and fetal hypoxia
PPH syndrome
premature detachment of the normally located
placenta
miscarriage

34. During labor, blood pressure, systolic and minute heart
volume increase
In the early postpartum period, postpartum collapses
may occur due to abrupt changes in intra-abdominal
and intrauterine pressures

35. During labor, blood pressure, systolic and minute
heart volume increase
Obstetric bleeding is most often coagulopathic,
character against the background of functional
inferiority of the liver

36.  with circulatory compensation in a pregnant woman

37.  circulatory insufficiency II-B - III stage;
 rheumocarditis II and III degree of activity;
 sharply expressed mitral stenosis;
 septic endocarditis;

38.  Coarctation of the aorta or evidence
of high arterial hypertension or
evidence of incipient aortic
dissection;
 severe persistent atrial fibrillation;
 extensive myocardial infarction and
signs of hemodynamic deterioration;
 combination of cardiac disease and
obstetric complications

39.  Decompensated malformation (whether
acquired or congenital)
 combined multicompartmental malformations

40. Delivery in a cardiac inpatient unit