Medical Management of the Pregnant Patient (original) (raw)
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Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center
International Journal of Cardiology, 2011
Prediction of adverse maternal and neonatal events in women with heart disease is not well established. We aimed to assess cardiac, obstetrical and neonatal complications in pregnant women with heart disease referred to our tertiary care center and validate a previously proposed risk index. We included 227 women with cardiac disease followed for 312 pregnancies at our tertiary center from 1992 to 2007. Cardiac risk was assessed using the previously proposed Cardiac Disease in Pregnancy (CARPREG) score and its association with maternal and neonatal outcomes was determined. Maternal cardiac lesions were predominantly congenital (81.4%). CARPREG risk was low (score=0) in 66.3% and intermediate (score=1) in 33.7% pregnancies. Maternal cardiac events complicated 7.4% pregnancies, with pulmonary edema occurring most frequently (3.8%). An intermediate score was associated with a higher rate of cardiac events (19.0% vs. 1.4%, odds ratio [OR] 15.6, 95% confidence interval (95%CI) 4.5-54.4, p<0.0001). Adverse events occurred in 27.5% neonates. Preterm deliveries occurred in 16.7% pregnancies, more commonly in patients with intermediate scores (OR 2.4, 95%CI 1.2-4.6, p=0.01). The sensitivity and negative predictive values of a low score were respectively 87% and 99% for total cardiac events and both 100% for primary cardiac events including pulmonary edema and sustained arrhythmia. The CARPREG risk index has a high sensitivity and negative predictive value with regards to cardiac complications in pregnant women with heart disease. It may, therefore, be routinely used to improve the assessment of cardiac risk before and during pregnancy.
Pregnancy with congenital heart disease
Vessel Plus, 2022
Pregnancy is complicated by maternal cardiovascular disease in 1%-4% of cases. With advances in management of congenital heart diseases (CHDs), the survival to adulthood and childbearing age is increasing all over the world. The physiological adaptation during pregnancy adds to the hemodynamic burden of CHD, and, hence, many women are diagnosed with CHD for the first time during pregnancy, more so in developing countries. The type of underlying CHD and pre-pregnancy hemodynamics determine the risk of developing complications during pregnancy. Hence, pre-pregnancy risk stratification and counseling are a crucial part of management plan. Some of the serious CHDs are best treated in the preconception stage. The maximum chance of developing complications is between 28 and 32 weeks of gestation, during labor, and up to two weeks after delivery. Common complications in women with CHD during pregnancy and labor include heart failure, arrhythmias, bleeding/thrombosis, infective endocarditis, and rarely maternal death. Fetal complications include abortion, stillbirth, prematurity, low birth weight, and CHD. Comprehensive knowledge of these complications and their management is very important as an experienced multidisciplinary team is critical for improving outcome of these patients. Special care is required for pregnant women who have pulmonary hypertension, due to either Eisenmenger syndrome or other causes, severe valve stenosis, aortopathy associated with bicuspid aortic valve/coarctation, or severe cyanotic CHDs. Most women with CHD are at low risk, and successful pregnancy is feasible in the majority with optimal management.
Congenital Heart Disease and Pregnancy. What Do We Know in 2008?
Revista Espanola De Cardiologia, 2008
Cardiac disease is the leading medical cause of material death during pregnancy in the United Kingdom. 1 Due to recent advances in cardiac surgery and congenital heart disease, the butter is now the most common subtrate of heart disease in pregnancy in the western world. 2 The combination of cardiac disease and pregnancy carry mortality and morbidity risks such as heart failure, thromboembolism, and cardiac arrhythmia. Furthermore, fetal and neonatal adverse events, including intrauterine growth restriction, premature birth, intracranial haemorrhage, and fetal loss are relatively common. Prepregnancy counselling (Table), including advice on contraception, and optimal care during pregnancy is, thus, becoming a major topic in current cardiologic and obstetric practice. The first task is to asses the risks of pregnancy for the mother. Pregnancy is associated with profound changes in peripheral resistance, cardiac output, and blood volume, in order to provide appropriate uterine blood flow. In the first trimester of pregnancy, the blood pressure falls secondary to a drop in peripheral vascular resistance. Thereafter, plasma volume increases by 25%, and this change in volume is associated with an accelerated heart rate and a 50% increase in cardiac output. Blood pressure starts to rise in the beginning of the third trimester. Structural changes to the heart and great vessels also occur and include myocardial hypertrophy, chamber enlargement, and valvular regurgitation. 3-11 These major cardiovascular changes may, in women with cardiac disease, be poorly tolerated and precipitate heart failure and clinical decompensation. Proarrhythmic effects and
Cardiac disease in pregnancy: still an arduous conundrum for the obstetrician
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Cardiac diseases, complicating about 1 percent of all pregnancies, account for significant maternal morbidity and mortality by being the leading cause of obstetrical intensive care unit admissions and of indirect maternal deaths. Of late, there has been observed a changing pattern in heart disease, the etiology having shifted from primarily rheumatic to predominantly congenital (75-82%), with shunt lesions preponderating (20-65%). Counseling and management of women of childbearing age with suspected cardiac disease ought to commence prior to conception; they should be managed by interdisciplinary teams; high risk patients must be treated in specialized facilities, and diagnostic procedures and interventions should be executed by mavens with profound expertise in the cardiovascular diseases and proficiency in treating pregnant women. This article provides a comprehensive review on management of cardiac disease in pregnancy to assist obstetricians in tackling this mystifying medical situation effortlessly, attaining a favorable feto-maternal outcome.
Pregnancy: Maternal and Fetal Heart Disease
Current Problems in Cardiology, 2007
Cardiac disorders complicate less than 1% of all pregnancies. Physiologic changes in pregnancy may mimic heart disease. In order to differentiate these adaptations from pathologic conditions, an in-depth knowledge of cardiovascular physiology is mandatory. A comprehensive history, physical examination, electrocardiogram, chest radiograph, and echocardiogram are sufficient in most cases to confirm the diagnosis. Care of women with cardiac disease begins with preconception counseling. Severe lesions should be taken care of prior to contemplating pregnancy. Management principles for pregnant women are similar to those for the non-pregnant state. A team approach comprised of a maternal fetal medicine specialist, cardiologist, neonatologist, and anesthesiologist is essential to assure optimal outcome for both the mother and the fetus.
Cardiac disease in pregnancy – A retrospective study
Indian Journal of Obstetrics and Gynecology Research, 2020
Objectives: To evaluate the maternal and perinatal outcomes in patients with cardiac disease in pregnancy. Materials and Methods: Medical records of 185 women with heart disease who delivered at ≥28 weeks of gestation from January 2011 to December 2015 at JSS Hospital, Mysuru, were studied. Results: The prevalence of heart disease in pregnancy was 1.76%. There were 77 (41.6%) women with congenital heart disease and 72 (38.9%) with rheumatic heart disease. 61.6% of the women were from rural background, and 38.4% were from the urban areas. Isolated mitral stenosis was the most common defect in those with rheumatic heart disease; and atrial septal defect was the most common congenital lesion seen. 80% of women remained NYHA class I throughout pregnancy. 53 women who underwent corrective procedures prior to, or during pregnancy had a good outcome. The maternal mortality rate was 1.4%. 44 % of women were primigravidas. The incidence of pre term labor was 15%. Vaginal delivery was preferred, and the second stage of labor was cut short with either outlet forceps or the vaccum cup. LSCS under regional anesthesia for obstetric indications was well tolerated. 31% of newborns were of low birth weight (<2.5 kg). Conclusions: Cardiac disease is an important cause of maternal and perinatal morbidity and mortality. Patients with NYHA class I/II had a better maternal and fetal outcome than those with NYHA class III/IV. Surgical correction of the cardiac lesion prior to pregnancy was associated with better pregnancy outcome.
International journal of scientific research, 2021
Risk Factors: 1. Pregnancy itself raises the risk of Acute Myocardial Infarction by three to four fold. 2. Risk 30 times Higher for women over the age of 40 Years compared with less than 20 years of age. 3. Other Risk factors include Chronic Hypertension, Preclampsia, Diabetes, Smoking, Obesity and Hyperlipidemia. Signs and Symptoms: Tiredness, rising pulse rate, murmurs, shortness of breath, loss of consciousness, palpitations etc. In tertiary centers an exercise treadmill test is rst non-invasive test of choice, other tests include, ECG, Echocardiography and chest X-Ray with abdominal shield if needed. Ÿ Cardiac disease in pregnancy is broadly divided into congenital and acquired. Ÿ The acquired group includes Rheumatic Heart Disease, cardiomyopathies and Ischemic Heart Disease. Ÿ In developing countries, Rheumatic Heart Disease is most common type. Mitral Stenosis is most common in Rheumatic Heart Disease. Ÿ In developed countries cardiomyopathies and congenital heart disease are most common. Ÿ Hemodynamic changes during pregnancy begin by rst 5-8 weeks and peak in second trimester, maximum is seen during labor and immediate postpartum. Ÿ These changes are well tolerated in a normal mother when compared to diseased heart. Ÿ Thus pregnancy has profound effect on the patient with cardiac disease as it increases cardiac work and their combined effect may exceed the limited functional capacity of the diseased heart. Ÿ This can precipitate congestive heart failure, pulmonary edema, also sudden death may occur. Ÿ Fetal morbidity is due to preterm delivery and fetal growth restriction, due to their inability to maintain an adequate uteroplacental circulation. Ÿ Fetal death is usually secondary to chronic severe or acute maternal deterioration. Ÿ The frequency of these problems depends on the severity of functional impairment of the heart and the severity of the chronic tissue hypoxia. Ÿ Keeping this in mind this study was undertaken in tertiary care hospital to increase knowledge about prevalence and severity of the disease so proper management and timely intervention can be done.
Cardiac disease and pregnancy: hyper vigilance and extreme caution for optimal outcome
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Cardiac disease in pregnancy is a leading cause of maternal death in more so high-income countries. The armamentarium for winning this difficult battle involves shared decision-making with communication across the clinical team and the patient. There is limited clinical evidence concerning effective approaches to managing such complex care and moreover involvement of different specialists makes coordinated care challenging. Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1-2% of the population whereas a single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. We had two cases of pregnancy with bicuspid aortic valve in one case and the other with single ventricle. The involvement of multidisciplinary team involving cardiologist, cardiothoracic anaesthetist and fetal maternal medicine specialist resulted in good maternal and fetal outcome in both the cases.