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DISEASE IN PREGNANCY
1.Antenatal management
2.Termination of pregnancy
3.Management of labour
4.Management of cardiac failure
Megavarnen 037012
MANAGEMENT
Patient wo have heart disease in pregnancy should be manged by obstetrician
and cardiologist
Management should be optimized following assesment of functional class of
the heart disease
1.Antenatal management
2.Termination of pregnancy
3.Management of labour
4.Management of cardiac failure
1. ANTENATAL MANAGEMENT
Routine antenatal visit to obstetricians and cardiologist
All vital signs should be check and evaluated
Routinely examined for signs and symptoms of cardiac failure
Fetal well being assessed routinely
Patient warned against any type of infection. Eg respiratory and dental infections
Anemia if present should promptly corrected
Presence of arrhythmias and breathlessness should thoroughly investigated
In brief
TERMINATION OF PREGNANCY
Not generally advised
Maybe terminated in condition like inoperable cyanotic heart disease, primary
pulmonary hypertension with eisenmenger's syndrome.
Preferably done before 8 weeks
1. cardiac surgery is not contraindicated in pregnancy but generally it is delayed until
postpartum period
2.antenatal admission not required for all patient.
patient with high risk factors such as infection, anemia, or arrhythmias should be
admitted early.
Best treatment offered in tertiary centre with facility of ICU jointly by obstetrician and
cardiologist.
MANAGEMENT OF LABOUR
Patients with heart disease deliver vaginally following spontaneous onset of labour
Induction of labour less frequently indicated
Artificial rupture of membrane better avoided- to minimize risk of infection
Patient should be covered with antibiotics during the course of labour
Ampicillin plus gentamicin therapy recommended against bacterial endocarditis.
Parenteral fluid administration closely monitored- to avoid overload
Labour pain controlled with epidural anesthesia- measure taken to avoid hypotension
Duration of second stage of labour cut short with use of( prophylactic outlet forces and
ventouse)
Ergometrine should not routinely given in third stage of labour
During labour, patient should have electrocardiographic monitoring when indicated