Flashcards in Maternal cardiac Deck (174)
What is NYHA (New York Heart Association) class 1?
No cardiac symptoms
What is NYHA (New York Heart Association) class II?
Cardiac symptoms with greater than normal activity (e.g., carrying packages)
What is NYHA (New York Heart Association) class III?
Cardiac symptoms with normal activity (e.g., getting dressed)
What is NYHA (New York Heart Association) class IV?
Cardiac symptoms with bedrest
With which two NYHA classes is pregnancy not advised?
How does cardiac dysfunction present?
Fatigue, limited activity, palpitations, tachycardia, SOB, chest pain, dyspnea on exertion, cyanosis
What 4 cardiac conditions are contraindications to pregnancy?
Severe ventricular dysfunction
Aortic root dilation (>4cm)
Severe left-sided obstructive lesions
While cardiac disease complicates 1-4% of pregnancies, it accounts for what % of maternal mortality?
Up to 25%
For women with congenital heart disease, what is the risk of fetal transmission?
5% (from 8/1000 background risk)
What features of pregnancy physiology can exacerbate cardiac disease?
Increased intravascular volume
What are the general guidelines for pregnancy management in women with cardiac disease?
Treat other medical conditions
Monitor fetal growth q 4-6w
What are the general guidelines for labor management in women with cardiac disease?
Lateral decubitus position
+/- Endocarditis prophylaxis
Avoid hypotension (keep women ?wetter?)
C/S for obstetric indications
While most cardiac conditions benefit from relative hypervolemia and relative hypotension intrapartum, what is the exception?
Why is fluid overload (ie post-partum autotransfusion) bad for mitral stenosis?
The associated restricted LV filling can lead to pulmonary edema
What are the indications for c/s with maternal cardiac disease?
Aortic root dilation >4cm
Severe aortic stenosis
Which cardiac patients/diagnoses may benefit from invasive monitoring in labor?
Women with preload dependent conditions (aortic stenosis, PHTN)
Should women with prospthetic cardiac valves receive endocarditis prophylaxis?
Yes (during endothelialization)
After what time period after repair of CHD with prosthetic material should women receive endocarditis prophylaxis with delivery?
Does completely repaired CHD (with repair >6m ago) require endocarditis prophylaxis?
Does unrepaired cyanotic CHD require endocarditis prophylaxis?
If your patient had repair of CHD with prosthetic material remotely but there are residual defects, should they receive endocarditis prophylaxis?
How do we manage a patient with prior infective endocarditis in labor?
With endocarditis prophylaxis
When endocarditis prophylaxis is indicated, what antibiotic is used?
Ampicillin 2g IV
For PCN allergic women who need endocarditis prophylaxis, what antibiotics can be used?
clindamycin, cefazolin, cetriaxone
Is there an ACOG resource to guide endocarditis prophylaxis?
Yes - committee opinion 421, Antibiotics prophylaxis for infective endocarditis
What is the workup for palpitations?
Rule out drugs/caffeine/tobacco
Are PACs and PVCs more common in pregnancy and typically benign?
What is the risk of complication or death in pregnancy with isolated VSD, repaired or unrepaired (high, moderate, or low)?
When you have a patient with a long-standing large VSD, what should you rule out prior to becoming pregnant?