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    Cardiac Disease Pregnancy

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    adhitia nugrahanto
    Cardiovascular diseases complicate over 1% of pregnancies and are a leading cause of indirect maternal death. During pregnancy, cardiac output increases by 40% primarily through increased stroke volume and heart rate. For women with underlying heart disease, these physiological changes may cause heart failure. Precise diagnosis of heart disease can be challenging during pregnancy due to normal adaptations. Labor should be managed carefully depending on the duration, difficulty, and risk of procedures for both mother and baby. Close monitoring is important during labor and postpartum.

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    Cardiac Disease Pregnancy

    Uploaded by

    adhitia nugrahanto
    79 views16 pages
    Cardiovascular diseases complicate over 1% of pregnancies and are a leading cause of indirect maternal death. During pregnancy, cardiac output increases by 40% primarily through increased stroke volume and heart rate. For women with underlying heart disease, these physiological changes may cause heart failure. Precise diagnosis of heart disease can be challenging during pregnancy due to normal adaptations. Labor should be managed carefully depending on the duration, difficulty, and risk of procedures for both mother and baby. Close monitoring is important during labor and postpartum.

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    Cardiac disease on pregnancy

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    Cardiovascular diseases complicate over 1% of pregnancies and are a leading cause of indirect maternal death. During pregnancy, cardiac output increases by 40% primarily through increased stroke volume and heart rate. For women with underlying heart disease, these physiological changes may cause heart failure. Precise diagnosis of heart disease can be challenging during pregnancy due to normal adaptations. Labor should be managed carefully depending on the duration, difficulty, and risk of procedures for both mother and baby. Close monitoring is important during labor and postpartum.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    79 views16 pages

    Cardiac Disease Pregnancy

    Uploaded by

    adhitia nugrahanto
    Cardiovascular diseases complicate over 1% of pregnancies and are a leading cause of indirect maternal death. During pregnancy, cardiac output increases by 40% primarily through increased stroke volume and heart rate. For women with underlying heart disease, these physiological changes may cause heart failure. Precise diagnosis of heart disease can be challenging during pregnancy due to normal adaptations. Labor should be managed carefully depending on the duration, difficulty, and risk of procedures for both mother and baby. Close monitoring is important during labor and postpartum.

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    Synopsis: Cardiovascular Diseases

    in Pregnancy

    ER TEAM January 2015


    Epidemiology

    ⬜ Complicates > 1% of all pregnancies

    ⬜ 7.6% severe obstetrical morbidities

    ⬜ Leading cause of indirect maternal deaths (20%).


    ⬜ RSCM → 44%

    ⬜ Most frequent event: hypertensive disorders (6-8%).


    Physiological Considerations in Pregnancy

    ⬜ Cardiac output increases 40%


    ⬜ Maximal by midpregnancy
    ⬜ First increase in stroke volume, then decrease in SVR, then
    increased end-diastolic ventricular volume.
    ⬜ Later in pregnancy → increased heart rate

    ⬜ Women with underlying cardiac disease may not always


    accommodate these changes → ventricular dysfunction
    → cardiogenic heart failure.
    ⬜ Mostly develops peripartum, some after 28 weeks, rarely
    before midpregnancy
    Physiological Considerations in Pregnancy
    Physiological Considerations in Pregnancy

    ⬜ Physiological changes in pregnancy can affect


    absorption, excretion, and bioavailability of all drugs.

    ⬜ Higher dosage of drugs are required to achieve


    therapeutic levels
    ⬜ Due to increased intravascular blood volume, raised renal
    perfusion, higher hepatic metabolism
    ⬜ Drug dose adjustment
    Effect of Pregnancy on Maternal
    Heart Disease

    ⬜ Changes in pregnancy that exceeds maternal capacity


    → heart failure, pulmonary edema

    ⬜ Danger periods of cardiac decompensation:


    ⬜ 12-16 wga → hemodynamic changes begin
    ⬜ 28-32 wgs → maximum changes
    ⬜ Labor & delivery → fluctuations in CO due to uterine
    contractions (increase) and maternal pushing (decrease).
    ⬜ After delivery of placenta → backflow
    ⬜ 4-5 days after delivery
    Effect Maternal Heart Disease on
    Pregnancy

    ⬜ Pregnancy outcome is compromised by presence of


    cardiac disease.

    ⬜ Fetal death → due to maternal deterioration.

    ⬜ Fetal morbidity → preterm, IUGR, congenital heart


    disease

    ⬜ Mostly due to chronic tissue hypoxia


    Diagnosis of Heart Disease

    ⬜ Physiological
    adaptations of normal
    pregnancy may
    induce symptoms &
    alter findings that may
    confound diagnosis of
    heart disease.
    Diagnose and Treat Heart Disease in
    Pregnancy
    Radiation exposure in cardiovascular
    diagnostic procedures
    NYHA Classification
    Predictors of Cardiac Events
    Labor Management
    ⬜ Vaginal delivery is a better option than CS
    ⬜ Risk of bleeding, infection, clotting complications are less
    ⬜ CS is associated with DVT, TE
    ⬜ Not associated with acute shift in blood volume

    ⬜ BUT Take into consideration:


    ⬜ Duration of labor
    ⬜ Difficulty of vaginal delivery
    ⬜ It may be preferable to perform a quick CS than a long and
    difficult vaginal delivery.
    Labor Management
    Post-partum care
    ⬜ Uterotonics
    ⬜ Slow IV oxytocin infusion (< 2 U/min) → avoid systemic
    hypotension.
    ⬜ Prostaglandin F analogues
    ⬜ Methylergonovine → contraindicated due to risk (> 10%) of
    vasoconstriction and hypertension.

    ⬜ Early ambulation, elastic bandage → reduce risk of TE

    ⬜ Hemodynamic monitoring → at least 24 hrs (risk of heart


    failure)

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