2 - Cardiovascular Complications Liu Wei Department of...

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Unformatted text preview: Cardiovascular Complications Liu Wei Department of Ob & Gy Ren Ji hospital Ren General Consideration • Cause of mother death The 2nd cause The • Incidence 1%-4% 1%-4% General Consideration • Antenatal cardiovascular changes 1. Blood volume increase by 40%-60% increase Peaking at 32 –34 weeks Peaking the expansion in plasma volume is greater than that expansion of red cell mass. than 2. Cardiac output Increase by 40%-50% Increase Peaking at 20-24 weeks Peaking General Consideration 3. Blood pressure Decrease in the first trimester Decrease Rise to prepregnancy levels in the third trimester trimester 4. Heart size Ventricular chamber size is increased Ventricular Systolic function is unchanged. Systolic General Consideration • Intrapartum cardiovascular changes 1. First-stage labor 300ml –500ml↑(each contraction) 300ml Cardiac output↑(maternal pain, anxiety) Cardiac (maternal 2. Second-stage labor 2. Lung circulation↑(bearing-down efforts to Lung (bearing-down expel the fetus) expel Venous return↓(after fetus is deliveried) Venous Placental circulation is lost (after placenta is deliveried) deliveried) General Consideration 3. Postpartum Circulating blood volume↑(Placental circulation (Placental is lost) is Circulating blood volume further↑(mobilization (mobilization of extravascular fluid into the vascular system) system) Types of Cardiovascular Complication • Congenital heart disease 先先 : the most frequent 1. Left to right shunting 先先先先先先 1) Atrial septal defect (ASD) 先先 : most common asymptomatic (most patients); pulmonary blood flow↑(lesion ≥2cm2) → pulmonary hypertension flow → Eisenmenger’s syndrome Eisenmenger’s 2) Ventricular septal defect (VSD) 先先 tolerated (small lesion); left ventricular hypertrophy→ pulmonary hypertension→ hypertrophy biventricular hypertrophy biventricular Types of Cardiovascular Complication 3) Patent ductus arteriosus (PDA) 先先先先先先 rare (early surgical repair); hemodynamic consequence are similar to VSD consequence 2. Right to left shunting 先先先先先先 1) Tetralogy of Fallot 先先先先先先 Pulmonary stenosis, right ventricular Pulmonary hypertrophy, large ventricular septal defect and overriding aorta and the most common cyanotic lesion complicating the pregnancy pregnancy Types of Cardiovascular Complication 3. Non-shunting 1) Pulmonary stenosis Not usually progressive Not 2) Aortic stenosis rare; its outcome is bad rare; 3) Marfan’s syndrome (genetic disorder) Myxomatous degeneration of the heart valves; mitral and cystic medial necrosis 先先先先先先 valves; 先先 of the aorta (aneurysms 先先先 ) of death rate: 4%-50% death Types of Cardiovascular Complication • Rheumatic heart disease 1. Mitral stenosis is the most common lesion. 2. Severe lesion with pulmonary hypertension→ pulmonary edema → hear failure: terminate the pregnancy the • Heart disease caused by preeclampsia Left heart failure (increased blood pressure and cardiac muscle ischemia) and Types of Cardiovascular Complication • Peripartum cardiomyopathy 1. Congestive cardiomyopathy (during the late Congestive stage of pregnancy (3 months) or within the first 6 months postpartum) first 2. Absence of other causes of heart failure 3. Its etioloty is uncertain 4. Manifestations: symptoms caused by heart Manifestations: failure and embolism failure 5. The risk of maternal mortality is 30%-50%. Types of Cardiovascular Complication • Myocarditis 先先先 Myocarditis 先先先 1. Manifestation: arrhythmia 先先先先 2. Sequelae of myocarditis 先先先先先先 : more common Effects on fetus • • • Preterm labor, fetal death, fetal distress Drug used Inherited problem Ventricular septal defect (VSD): 22% Ventricular Marfan’s syndrome: 50% Marfan’s Diagnosis • Etiology diagnosis congenital or rheumatic or preeclampsia or peripartum cardiomyopathy peripartum • Anatomy diagnosis ASD or VSD or PDA or mitral stenosis or mitral regurgitation regurgitation • Pathophysiology diagnosis pulmonary hypertension or Eisenmenger’s syndrome or arrhythmia syndrome • Functional classification Class: I—IV Class: Diagnosis • more significant signs 1. History: palpitation( 先先 ), short breath, heart ), disease disease 2. Orthopnea ( 先先先先 ), chest pain, expectoration ), of blood ( 先先 ) of 3. Cyanosis 先先 , diastolic murmur 先先先先先 4. Arrhythmia 5. Enlargement of heart (chest x-ray film) 6. Echocardiogram: chamber enlarge, Echocardiogram: hypertrophy, abnormality of valve Functional classification of heart disease • 1. 2. 3. New York Heart Association (NYHA) Class I: asymptomatic Class II: symptoms with normal activity Class III: symptoms with less than normal Class activity activity 4. Class IV: symptoms at rest • Revised guideline According to the result of objective testing (chest According x-ray, EKG, echocardiogram) x-ray, early diagnosis of heart failure • Palpitation and short breath with less than Palpitation normal activity normal • HR>110, R>20 at rest • Orthopnea at night • Persistent wet rale in lung Judgment of safety of pregnancy • 1. 2. 3. 4. 5. 6. 7. 8. 9. Conception should be prevented if: Severe heart disease Functional classification: class III-IV History of heart failure Pulmonary hypertension Right to left shunting Severe arrhythmia rheumatic fever 先先先 Combined valve disease Acute myocarditis Treatment • Antenatal treatment 1. Termination of pregnancy: Terminate before 12 weeks (cases not suitable to pregnancy) to 2. Antenatal supervise: regular and intensive Antenatal and early (early pregnancy) and 3. Prevention of heart failure 1) sufficient rest 2) weigh control 3) preventing infection, correcting anemia and preventing arrhythmia arrhythmia Treatment 4. 1) 2) 3) 4) Treatment of heart failure Cardiotonic 先先 : digoxin Vascular dilation Diuretic 先先 Caesarean section Treatment • Intrapartum treatment 1. Method of delivery: CS 2. First stage calm down, ataractic( 先先先 ), oxygen supplement 3. Second stage Operative vaginal delivery 4. Third stage Preventing postpartum hemorrhage 5. Puerperium Preventing infection END ...
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