HEART DISEASES IN PREGNANCY

PRINCIPLES

•EARLY DIAGNOSIS AND EVALUATION

•DETECT HIGH RISK FACTORS 

•PREVENT CARDIAC FAILURE

•COMBINED CARE.

ANC 

•TERTIARY CARE HOSPITAL

•CARDIOLOGIST

•COUNSELLING

•SPECIAL CARE – RISK FACTORS LIKE INFECTIONS……..

•Inj.BENZATHINE PENICILLIN at an interval of 4 weeks 

              to prevent recurrence of rheumatic fever…..

              avoid excess intake of caffeine,alcohol,high calorie diet

NYHA CLASSIFICATION

•GRADE 1 &2  :

                      once in 15 days till 30 weeks

                      once in a week till term

                      hospitalise at  36 & 28 weeks

 GRADE 3&4:

                      hospitalise 

                      rest

                      mild diuretics    (frusemide,thiazide)

                      diagnosed at 1st trimester – MTP is 

                       done

ANTICOAGULANTS

•It is necessary in cases of RHD

•Pts taking WARFARIN discontinue it. 

•HEPARIN 5000 units 2 times daily subcutaneously upto 12th week……

•Then WARFARIN 3mg daily -36 weeks….

•HEPARIN upto 7 days postpartum…..

•Warfarin  IS THEN CONTINUED…..

DANGER PERIODS

•12  -  32 WEEKS

•Labour

•Immediately after delivery

•4 – 5 days after delivery 

INDICATIONS FOR URGENT HOSPITALISATION

•Superimposed anemia 

•PIH

•Respiratory infections

•SBE

•ARRYTHMIA.

MANAGEMENT DURING LABOUR

FIRST STAGE……..

•PROPPED UP POSITION……

• OXYGEN BY MASK….

•MORPHINE   10 – 15mg IM/SC 

    PETHIDINE   iv 3-5 mg

• ANALGESICS  -  epidural.

• iv  FLUIDS 

• monitor pulse rate,RP,BP,BASAL CREPTS… (>110/min – iv digoxin 0.5mg )

•CVP monitored and prophylactic antibiotics for SBE are given….

•Given during labour and  2 doses after delivery….

• iv  AMPICILLIN 2gms

• iv  GENTAMICIN 1.5mg/kg at the onset of labour (8 hrs interval)…….

SECOND STAGE ……….

•CUT SHORT THE SECOND STAGE OF LABOUR by forceps or ventouse

•40mg of iv frusemide is given immediately after the baby is born …… 

•Avoid methergine

•Slow delivery

THIRD STAGE……..

•iv  OXYTOCIN to reduce the amount of bleeding…..

•Ergometrine  is  contraindicated ……..

•INTRAUMBLICAL ROUTE………..

•Discharge the patient after 2 weeks… 

INTRAPARTUM MANAGEMENT

•SPONTANEOUS ONSET OF LABOUR IS PREFERRED

•ADEQUATE PAIN RELEIF

•LATERAL RECUMBENT POSITION

•OXYGEN…….

•METICULOUS FLUID BALANCE

•CUT SHORT THE 2nd STAGE

•AVOID ERGOMETRINE

•IE prophylaxis……

CAESAREAN SECTION ………..

•Obstetrical indications 

• Coarctation of aorta 

• anaesthesia – either epidural or general………

•PUERPERIUM 

              1.  observe patients for first 24 hrs

              2.  oxygen is administered 

              3.   hourly pulse , BP , respiration are 

                   recorded……….

              4.   Breast feeding is contraindicated in 

                     grade 3 & 4……….

              4.   prevention of complications ……..

•CONTRACEPTION : 

      1. COMBINED METHOD  , BARRIER METHOD… 

      2. STERILISATION  at the end of the 1st 

                week by minilap technique……..

      3. STERIODAL contraception is

                contraindicated………

      4. VASECTOMY…….

      5.IUCD  -  cut the thread……

                          

RHEUMATIC MITRAL STENOSIS

•Commonest heart lesion met during pregnancy.

•Stenosis <2.5cm..

• mortality 5-15%....in grade 3&4….

•Place of valvotomy – unresponsive cases

• surgery 14 – 18 weeks….

SURGERY

•Valve replacement 

•Commisurotomy

•Balloon-valvuloplasty  can be carried out in 2nd trimester

•Complication – atrial fibrillation…….

INDICATIONS FOR VOLVOTOMY

•PULMONARY EMBOLISM

•THROMBOEMBOLISM

•REPEATED FAILURE

•UNRESPONSIVE CASES……………..

PROGNOSIS

•AGE 

•h/o previous pregnancy

•Functional class

•SES

•Arrythmia

•Nature of lesions…. 

Thank you...
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