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Chapter-18 Heart Disease in Pregnancy

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

Author
1. Nagpal Monika B
2. Malhotra Shalini
ISBN
9789380704739
DOI
10.5005/jp/books/11228_18
Edition
1/e
Publishing Year
2010
Pages
20
Author Affiliations
1. Lady Hardinge Medical College and SSK Hospital, New Delhi, India
2. Lady Hardinge Medical College and SSK Hospital, New Delhi, India, Al Qassimi Hospital, Sharjah, UAE, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital (RMLH), New Delhi, India
Chapter keywords

Abstract

Cardiac disease is among the leading causes of maternal mortality during pregnancy and it complicates approximately 0.8% of pregnancies. The physiologic cardiovascular adaptations of pregnancy are well tolerated by healthy women but the same can significantly compromise women with heart disease. For each patient, the prepregnancy cardiovascular status should be established and used as a reference in assessing any pregnancy related cardiac changes. It is important to counsel the women about the risk of maternal mortality due to the specific cardiac lesion before conception. Any additional risk factors which might worsen the outcome like anemia, thyrotoxicosis, etc. should be evaluated and corrected before conception to optimize the fetomaternal outcome. The risk of the congenital heart disease in the baby in a woman with congenital heart disease varies from 3–50% depending on the specific lesion. The hyperdynamic circulation of pregnancy causes alterations in the physical findings in the cardiovascular system which can mimic heart disease. The clinical findings suggestive of heart disease include presence of cyanosis, clubbing, persistent neck vein distention, systolic murmur grade 3/6 or greater, diastolic murmur, cardiomegaly, persistent arrhythmia and persistent split second sound and require further investigation. Women with cardiac disease should avoid strenuous activity and contact with persons with respiratory infections. Labor, delivery and postpartum are periods of hemodynamic instability and require intensive monitoring. Vaginal delivery is preferred as hemodynamic fluctuations and blood loss are more common with cesarean delivery. Intrapartum antibiotic prophylaxis against bacterial endocarditis should be used when bacteremia is suspected according to the recommendations.

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