Heart diseases with preg

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