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CARDIOVASCULAR PHYSIOLOGY
normal physiological changes occur during pregnancy, both blood volume and cardiac output increased by 40 % cardiac output increased is result from increase in both heart rate and stroke volume greatest increase is seen within 1st trimester, peak at around 24 weeks
Fetal risk 1) Intrauterine growth restriction 2) preterm delivery 3) congenital heart disease
Antenatal management
Managed in a joint obstetric/cardiac clinic Monitor sign/ symptom of heart failure and any sign of deteriorating cardiac status - Breathlessness - tachycardia - reduced in effort tolerance NEW YORK HEART ASSOCIATION
Avoid risk factor for development of heart failure Respiratory infection anaemia obesity tocolytic fluid overload pain related stress The use of anticoagulant Warfarin is teratogenic if used in first trimester Replacing warfarin with heparin in 1st pregnancy
use prophylactic antibiotic for those with structural anomalies of the heart, prosthetic heart valves. Standard Regime 1 Ampicillin (IV or IM 2gm) + Gentamycin (IV or IM 1.5mg/kg not to exceed 80 mg) amoxycillin 1.5 g orally 6 hours after initial dose (single dose0 Standard Regime 2 Ampicillin (IV or IM 2GM) + Gentamicin (IV or IM 1.5mg/kg, not to exceed 80 mgamoxycillin 2gm IV or IM 8 hours after initial dose (single dose)
Patients is allergic to penicillin - Antibiotic to be given 1 hour before procedure Vancomycin (IV 1gm over 1 hour) + Gentamicin (IV or IM 1.5mg/kg not to exceed 80 mg) repeat 8 hours for both antibiotic, same dosage.
Mother should remain propped up position and give oxygen supplementation careful haemodynamically monitoring - Cardiac monitoring - Pulse oximeter - Vital sign (BP, HR, temp every hour) - strict i/o charting (ensure fluid balance) Analgesia - Epidural can be offered depend on nature of the heart disease and degree of heart failure.
Keep shorten second stage Via instrumental delivery Use syntocinon Precaution Avoid usage of pethidine ( can cause tachycardia) Avoid lithotomy position (can cause sudden increased in venous return) - avoid ergometrine (can cause vasoconstriction, hypertension,heart failure) After delivery , observe closely for 24 hours in HDU