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MIDW2001 Complexities In Childbearing > Cardiac Disease > Flashcards

Flashcards in Cardiac Disease Deck (16):

how many maternal deaths are due to cardiac disease?


leading cause of indirect maternal death


list the changes of the cardiac system in pregnancy:

fall in systemic vascular resistance to 30-70% by 8/40 - results in fluid retention and an increase in blood volume

increased cardiac output - begins to rise in 1st trimester and rises to peak at 32/40 by 30-50%. Achieved by rise in stroke volume and HR

increased blood volume and cardiac output and reductions in systemic vascular resistance and BP

plasma volume reaches a maximum of 40% above baseline at 24/40


what happens to blood pressure during pregnancy?

remains almost pre pregnant levels

slight tendency to fall, particularly during mid trimester as the vascular resistance falls


what do these changes effect?

absorption, excretion and bioavailability of all drugs

raised renal perfusion, higher metabolism


what intrapartum changes occur to BP and cardiac output?

SBP increases 15-25%
DBP increases 10-15% during uterine contractions

cardiac output- increases by 15% in early labour, 25% during 1st stage and 50% during pushing

80% increase in CO in early postpartum due to auto transfusion related to uterine involution and leg oedema


what are the symptoms of cardiac disease?

can be easily disguised as normal pregnancy changes

fatigue, dyspnea, light headedness

there would be abnormal findings on an ECG or echo


How should collaborative care be involved with cardiac disease?

MBRACE 2016- women with CHD should ideally be managed by an MDT, obstetricians, cardiologists, anaesthetists, neonatologists, midwives.

pre pregnancy counselling is very important (RCOG 2011)


what should be involved in pre-conceptual counselling?

transition from paediatric cardiology inclusive of contraceptive advice (MBRACE, 2016)

obstetrician and cardiologist should work together to help make an informed decision

prevent an unwanted pregnancy and avoid the risks associated with pregnancy continuation or termination


what is the risk/likelihood of a cardiac event during pregnancy?

no other risk factors- 5%
one risk factor- 25%
2 risk factors - 75%


what plans should be in place for labour and delivery?

appropriate timing of delivery is crucial to balance the risks and benefits to mother and baby

clear plan of management should be established in advance, clearly documented and widely disseminated. generally- vaginal examination with low dose of epidural anaesthesia

careful monitoring of mother and fetus, careful BP monitoring and blood loss monitoring

nursing in left lateral ideally, never lying flat

forceps or vents delivery can be used to shorten maternal expulsive effort in second stage

antibiotic prophylaxis should be given during labour and delivery for most women

increased cardiac output in second stage - reduce time in second stage

pain induces sympathetic response, causing increased HR


what are the indications for ELLSCS?

aortopathy with aortic root >4cm

aortic dissection or aneurysm

warfarin treatment within 2 weeks


what is the plan for 3rd stage of labour?

return of uterine blood into systemic circulation results in further increase in cardiac output

bolus 10IU of oxytocin should be avoided as can cause severe hypotension

ergometrine, syntometrine avoided (hypertension)

misoprostol use is unclear of safety

low dose oxytocin infusion is preferred


what is the plan immediately after birth?

stroke volume, HR and CO remain high for 24 hours post delivery, high risk for pulmonary oedema

careful haemodynamin monitoring postpartum for 24-72 hours, should extended up to 2 weeks with pulmonary hypertension


what is the postnatal care?

lactation encouraged - reduces fluid retention .. unless woman in cardiac failure

cardiac output not compromised during lactation

MDT follow up should take place 6 weeks PN


what forms of contraception are advised?

barrier methods - unreliable

COC contraindicated

progesterone only pills have better side effects

mirena coil is good

sterilisation is ideal


what are signs to look out for if the woman health is deteriorating?

rising pulse rate - measure using stethoscope and auscultating heart RCOG 2011

BP should be monitored manually, seated comfortably, not talking, correct size cuff

raised RR and persistent breathlessness

severe chest pain, left arm or back pain