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Chapter-30 Medical Disorders in Pregnancy (Cardiac, Respiratory and Endocrine Disorders)

BOOK TITLE: Essentials of Obstetrics

Author
1. Konar Hira Lal
ISBN
9788180613623
DOI
10.5005/jp/books/10288_30
Edition
1/e
Publishing Year
2004
Pages
6
Author Affiliations
1. NRS Medical College, Kolkata, India
Chapter keywords
medical disorders, pregnancies, endocrine disorders, hemodynamic system, blood volume, pulse rate, cardiac output, cardiac load, cardiac disease, heart disease, labor, puerperium, hyperdynamic circulation, rheumatic diseases, cyanotic group, congenital cardiac disease, congenital heart diseases, atrial septal defects (ASD), patent ductus arteriosus (PDA), ventricular septal defects, coarctation of aorta, labor pain, epidural analgesia, hypotension, prophylactic outlet forces, ventouse, intravenous morphine, aminophylline and frusemide, pulmonary edema, digoxin, myocardial efficiency, chest infection, airway obstruction, physician, Physiotherapy, postural drainage, fetal growth restriction, pulmonary hypertension, hypoxemia, isolated thyroid nodule, goiters, ultrasonography, thyroid nodule, fine needle aspiration biopsy, hypothyroidism, hypothalamopituitary dysfunction, autoimmune disorders, surgical ablation

Abstract

Medical disorders complicating pregnancies are not uncommon. Cardiac, respiratory and endocrine disorders can alter the course of a pregnancy. There is significant alterations of the hemodynamic system during normal pregnancy. This is in terms of blood volume, pulse rate and cardiac output. Cardiac load increases during pregnancy. Women with cardiac disease may not be able to withstand such physiological changes during pregnancy. So it is essential that while managing heart disease in pregnancy obstetrician, cardiologists and the anesthesists should identify the high risk factors, anticipate the complications and manage the problems faced during pregnancy, labor and puerperium. A patient with cardiac disease presents with the features of hyperdynamic circulation. Pregnancy has no permanent deleterious effect on rheumatic diseases. Prognosis is good when compared to a cyanotic group of congenital cardiac disease. CHD when associated with pulmonary hypertension (primary or secondary) is associated with high maternal death. Commonly seen congenital heart diseases are atrial septal defects (ASD), patent ductus arteriosus (PDA), ventricular septal defects and coarctation of aorta. Labor pain is adequately controlled preferably with epidural analgesia, with measures to avoid hypotension. Duration of second stage of labor is cut short with the use of prophylactic outlet forces or ventouse. Intravenous morphine, aminophylline and frusemide are administered to reduce pulmonary edema. Digoxin is started to improve myocardial efficiency if she was not digitalized before. Chest infection and airway obstruction is managed in consultation with a physician. Physiotherapy and postural drainage are maintained. Fetal growth restriction has been observed. Pulmonary hypertension and hypoxemia are the two predictors of success for pregnancy outcome. Isolated thyroid nodule during pregnancy raise the suspicion of malignancy. Goiters during pregnancy are generally diffuse in character. Ultrasonography can be useful to evaluate a thyroid nodule. Fine needle aspiration biopsy can be safely performed in pregnancy when necessity arises. Hypothyroidism may be due to hypothalamopituitary dysfunction. More commonly it is due to autoimmune disorders or due to surgical ablation.

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