Post on 23-Dec-2014
description
HEART DISEASES WITH PREGNANCY
HEART DISEASES WITH PREGNANCY
Heart diseases with pregnancy
Incidence :
1-3 % of all pregnancies
( 90 % are rheumatic ) : Mitral
Classification :
1.NYHA : functional impairment
Class I : AsymptomaticClass II : Symptomatic with heavy exertion Class III : Symptomatic with light exertion Class IV : Symptomatic at rest
Classification :
2- ACOG Classification : according to maternal mortality :
Group I : MS. NYHA I, II → 0-1 % ASD , VSD , PDA
Group II : MS. NYHA III, IV AS, Aortic coarctation , MS with AF Artificial valve 5-15 %
Group III : Pulmonary HTN Aortic coarctation with valve involvement
:25 – 50 %
Pregnancy and heart disease relationship
☺ Effect of pregnancy on heart disease :
» ↑ cardiac work due to Haemodynamic changes » Heart Failure esp. during :
1. Pregnancy 28 – 32 wks2. Labour → 1st stage : Uterine cont.
→ 2nd stage : Straining → 3rd stage : Placental delivery
3. puerperium : 4th , 5th day : infection
☺ Effect of heart disease on pregnancy : ♠Mother :
› Pregnancy → polyhydramnios › Labour → Preterm labour› Puerperium : → PPH
→ puerperal sepsis → Mortality 10 %
♠ Fetus : › Abortion› Cong. Anomalies → Cardiac› IUGR› IUFD
Diagnosis
A – Clinical : ♠ History :
1.Past Hx. Of Cardiac troubles . 2.Complaint :
› Lung congestion
› Sys. Congestion
› Low COP
› Degree of functional impairment ( NYHA )
A – Clinical : ♠ Examination :
1. General : › Cyanosis , blue clubbing, congested neck veins
, oedma lower limb › Lung → basal crepitations › Heart → murmer , gallop
2. Abdominal :
› Fundal level ( gest. Age )
B – Investigations :
♠ ECG ♠ Echo ♠ Chest X- ray
Management
☺ Pre-conceptional Care : ♠ Calss I, II :
→ Allow to get preg. ♠ Class III, IV :
→ Advised not to get preg. → If occur :
› TOP is discussed with family. → If ptn. Insist to continue :
› Prolong Hospitalization › C.S better to be avoided .
☺ Pregnancy:
♠ ANC : frequent visits ( double )
♠ Bed rest
♠ Diet : salt restriction
♠ Drugs : Long acting penicillin Prophylactic digitalis
☺ Pregnancy:
♠Monitoring → Mother : › Anemia › Infection› HF› Preg. HTN
→ Fetus :› 1st : US› 2nd : US + Echo› 3rd : fetal wellbeing tests
☺ Pregnancy:
♠ Hospitlization :
› 28 – 32 wks › 36 wks → delivery› Complications
☺ Labour:
♠ Timing : → acc. To method → after fetus maturation
♠Method : → Vaginal delivery is the rule → C.S better to be avoided
♠ Precautions : ☼ 1st stage : position , drugs , avoid bearing down .☼ 2nd stage : shortening ☼ 3rd stage : Diuretics , Oxytocin ( with caution ) , No
Ergometrine
☺ Post partum care:
♠ Baby → examination for cardiac anomalies
♠Mother → Bed rest ( 2 wks ) & antibiotics
☺ Contraception :
♠ Tubal ligation ♠ Spermicidals & Mechanical ♠ IUD → infection ♠ P.O.Ps ♠ COCs → C.I
THANK YOU ☺
Contributors:Baligh Hamdy Ayman GamalBaraa Helal HassanBaha’a Elden MohammedBasem Abd El wahabTharwat Abu algamalEhab Aslan