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heart_disease_pregnancy - Cardiac Diseases in Pregnancy...

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12/24/11 Dr.Uma Dr.NK Gupta 1 Cardiac Diseases in Pregnancy Dr.Uma Gupta MD,FICMCH Dr.N.K.Gupta MS,MCh [email protected] [email protected]
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12/24/11 Dr.Uma Dr.NK Gupta 2 The incidence and changing pattern of heart disease It ranges from 0.1% to 4%. Hospital statistics - industrialized countries have shown a decrease in the incidence from 0.9% to 0.3%
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12/24/11 Dr.Uma Dr.NK Gupta 3 Incidence of heart disease……… Sharp decline in the incidence of chronic rheumatic heart disorders. Advances in the medical and surgical treatment of patients with congenital heart defects has resulted in an increased survival to reproductive age.
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12/24/11 Dr.Uma Dr.NK Gupta 4 Maternal mortality from heart disease Statistics have demonstrated a decline in maternal mortality from cardiac disease since 1950 from 5.6 to 0.3 per 100 000 births. B’s of improved medical care of the pregnant cardiac patient and a sharp decrease in the incidence of rheumatic heart disease.
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12/24/11 Dr.Uma Dr.NK Gupta 5 Maternal mortality from heart disease Confidential enquiry of latest report on maternal deaths in the United Kingdom, has shown that cardiac disease accounted for the greatest number of maternal deaths accounting for 35 (16.5%) of all maternal deaths over the period 1997–99* (37 of 323) in the 1991 to 1993 triennium (18) -1988 to 1990 trienniums (23) -1985 to 1987 * de Swiet M. Cardiac disease. In: Lewis G, Drife J, eds. Why Mothers Die 1997–1999 . The Confidential Enquiries into Maternal Deaths in the United Kingdom. London: Royal College of Obstetricians and Gynaecologists, 2001; 153–64
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12/24/11 Dr.Uma Dr.NK Gupta 6 Maternal mortality from heart disease Cardiac diseases is also the leading cause of indirect maternal death. Of the cardiac deaths reported to the Confidential enquiry between 2000- 2002, 40% were noted to have substandard care. Deans CL, Uebing A, Steer PJ. Cardiac disease in pregnancy. In Progress in Obstetrics and Gynaecology, Vol 17, Edi Studd J, Tan S L, Chervenak FA.Churchill Livingstone 2007, 164-182.
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12/24/11 Dr.Uma Dr.NK Gupta 7 Cardiovascular Physiology of Pregnancy Normal pregnancy is associated with an increase of 30 to 50 percent in blood volume Blood volume increases, starting at the sixth week and rising rapidly until mid pregnancy; the levels peak by 20 to 24 weeks of pregnancy and then are either sustained until term or decrease An estrogen-mediated stimulation of the renin- angiotensin system results in sodium and water retention appears to be the mechanism underlying the blood volume increase .
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12/24/11 Dr.Uma Dr.NK Gupta 8 Cardiovascular Physiology of Pregnancy Increase in cardiac output is most significant change during pregnancy. It begins to rise in first trimester and steadily rises to peak at 32 weeks by 30 to 50%. Cardiac output is normally 4.2 L/min., is 6.5 L/min. at 8-10 weeks of pregnancy and remains so till near term.
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