Heart Diseases in Pregnancy

Posted by e-Medical PPT
Mortality associated with specific cardiac lesions;
1. Low risk of maternal mortality (less than 1%).
              (a)  Septal defects.
              (b)  New York Heart Association classes I and II.
              (c)  Patent ductus arteriosus.
              (d)  Pulmonary / tricuspid lesions.
2. Moderate risk of maternal mortality (5-15%).
              (a)  NYHA classes III and IV mitral stenosis.
              (b)  Aortic stenosis.
              (c)  Marfan’s syndrome with normal aorta.
              (d)  Uncomplicated coarctation of aorta.
              (e)  Past history of myocardial infarction.

3. High risk of maternal mortality (25-50%).
              (a)  Eissenmenger’s syndrome.
              (b)  Pulmonary hypertension.
              (c)  Marfan’s syndrome with abnormal aortic root.
              (d)  Peripartum  cardiomyopathy.
What is the prognosis for a woman with a cardiac disease depending on the NYHA classification?
Prognosis depending on the functional status
In general, women in NYHA classes I and II lesions
       usually do well during pregnancy and have a
       favorable prognosis with a mortality rate of <1%.
Patients in NYHA classes III and IV may have a
       mortality rate of 5% to 15%. These patients should
       be advised against becoming pregnant.

What are the causes for increased cardiac output during a normal pregnancy?
Cardiac output begins to rise in the first trimester and continues as   steady increase to peak at 32 weeks gestation by 30% to 50% of pre pregnancy level.

Causes for increased cardiac output are
   1. Increases in stroke volume (early pregnancy)
   2. Increase in heart rate (late pregnancy)
   3. Decreased peripheral resistance
   4. Decreased blood viscosity

Physiological changes during labour and puerperium.
          1.First stage.
            Cardiac output increases by15%. Uterine contractions    
            increases venous return , causing increase in cardiac
            output & can cause reflex bradycardia.

         2.Second stage
            Increase in intra abdominal pressure (valsalva’s)
            causes decrease in venous return and  cardiac output.

         3.Third stage
            Normal blood loss during delivery
             (around 250-350  ml).
             It leads to
                a. Decrease blood volume
                b. Decrease cardiac output.
Criteria to diagnose cardiac disease during pregnancy:
    1.Presence of diastolic murmurs.
    2.Systolic murmurs of severe intensity (grade 3).
    3.Unequivocal enlargement of heart (X-ray).
    4.Presence of severe arrythmias, atrial fibrillation or  flutter
The indications for Termination of pregnancy.
 Because of high maternal risks, MTP is indicated in:
1.Eisenmenger’s syndrome.
2.Marfan’s syndrome with aortic involvement
3.Pulmonary hypertension.
4.Coarctation of aorta with valvular involvement.
    Termination should be done before 12 weeks of
       pregnancy.

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