Which groups of women are more likely to die during pregnancy?
Women with co-morbidities
Ethnic minority women
Overweight / obese women (cardiovascular disease risk i.e VTE)
What cardiovascular diseases are common causes of death in pregnancy?
Cardiac disease i.e MI
VTE i.e DVT, PE, stroke, MI
What cardiovascular changes occur in pregnancy?
Increased heart rate, contractility, stroke volume --> CO
Decreased BP and TPR
Why is the prevalence of heart disease in pregnancy increasing?
Increased maternal age
More obese women
More women with pre-existing or congenital heart disease
What is a major risk factor for ischaemic heart disease in women?
What innocent cardiovascular signs and symptoms are seen in pregnant women?
Which anticoagulant is teratogenic?
LMWH isn't, so swap it
Which cardiovascular disease is often fatal if carried into pregnancy?
What is Eisenmenger's syndrome?
Right-to-left shunt caused by PH secondary to a congenital heart defect e.g VSD
b) genetic disorders are associated with congenital heart disease?
b) Marfan's syndrome (aortic root dilation -> regurg)
+ a million more
Palpitations occuring during pregnancy are usually ___.
What cardiac investigations should be done for a woman presenting with palpitations?
If dodgy, do echo
Which endocrine diseases may cause palpitations in pregnant women?
Which NYHA class of cardiovascular disease is a contraindication for pregnancy?
make sure the woman is using contraception
What respiratory changes occur during pregnancy?
Increased oxygen consumption
Increased tidal volume BUT NOT respiratory rate
Decreased functional residual capacity (lungs are compressed by pregnancy)
What blood gas changes occur during pregnancy?
% O2 increases
% CO2 decreases
So blood pH increases
Palpitations is a common cardio complaint in pregnancy.
What is a common respiratory complaint?
Which chronic respiratory condition is often seen in pregnant women?
Why do many pregnant women experience a deterioration in their asthma early in pregnancy?
Concerns re: medication effect on baby (steroids, inhalers)
so they stop using them and their asthma gets worse
What should women on long-term steroids be given during childbirth?
IV steroids e.g hydrocortisone
bc. they will have adrenal insufficiency
Can women continue on their inhalers during childbirth?
What is the most common direct cause of maternal death in pregnancy?
Where exactly do DVTs tend to occur in pregnant women?
Iliac / femoral vein
When in the course of pregnancy does DVT tend to occur?
Virchow's triad for venous thromboembolism includes epithelial damage, hypercoagulability and venous stasis.
How do pregnant women fulfill these factors?
Epithelial damage - rapid cardiovascular changes
Venous stasis - lying down a lot, especially in hospital
Hypercoagulability - some women have thrombophilia
Which type of drug is given as prophylaxis for DVT in pregnant women?
NOT warfarin - LMWH
What congenital disease, causing hypercoagulability, causes DVT in pregnancy?
What LMWH is used for pregnant women in Tayside?
What influences the dose of dalteparin given to pregnant women to prevent VTE?
What investigation is used to diagnose DVT in pregnant women?
like a doppler for your leg