FETAL AND MATERNAL COMPLICATIONS new.pptx

Fetal and maternal complications in heart disease complicating pregnancy

1. FETAL AND MATERNAL COMPLICATIONS - ABI SHREE ARPUTHA P

2. Introduction Heart disease complicates about 1% of pregnancies and is one of the important indirect causes of maternal mortality in India. Of that, RHEUMATIC HEART DISEASE remains the most common contributing to 90-95% of cases .​ 2

3. MATERNAL COMPLICATIONS EFFECT OF PREGNANCY ON HEART DISEASE Although most women with uncomplicated mild cardiac diseases have an uneventful pregnancy and labor, complications do occur. 3 Presentation title 20XX

4. CONGESTIVE CARDIAC FAILURE Can occur with - chronic left heart failure, worsening NYHA class 2 to 3 or 4, right heart failure that may occur with pulmonary stenosis. Presents with - tachycardia, edema, raised JVP, gradually worsening dyspnea, orthopnea CCF during pregnancy or labor is treated with; salt and fluid restriction Inj. morphine 10mg IM single dose Inj. frusemide 40mg IV Inj. digoxin 0.5mg IM single dose (a cardiologist involvement is must in every stage) 4 Presentation title 20XX

5. ACUTE PULMONARY EDEMA Common in women with left atrial/ventricular outflow obstruction as seen in moderate to severe MITRAL STENOSIS and aortic stenosis Precipitating factors Antenatal – at 28-30 weeks when blood volume peaks Labor – due to pumping of blood from uterus, tachycardia Immediate postpartum – due to shunting of blood from placental bed Puerperium – due to mobilization of extravascular fluid Intercurrent events hypertension , anemia, multifetal pregnancy, thyrotoxicosis, acute febrile illness, atrial fibrillation 5 Presentation title 20XX

6. Manifestation Acute-onset of dyspnea, paroxysmal nocturnal dyspnea, cough with frothy sputum and hemoptysis, rales on auscultation Management Made to sit in a propped-up position Administration of oxygen Diuresis – large doses of IV frusemide Treatment of the precipitating cause Recurrent and intractable pulmonary edema due to tight mitral stenosis, an emergency closed mitral valvotomy may be required 6 Presentation title 20XX

7. ARRHYTHMIAS Atrial fibrillation is most common arrhythmia encountered Management Pulse is irregular, usually >110/min An ECG shows irregular ventricular rate and absent p waves is diagnostic -Digoxin reduces heart rate and controls the fibrillation - Beta blockers - metoprolol, bisoprolol, CCB - verapamil, anticoagulants - prevent thromboembolism 7 Presentation title 20XX

8. INFECTIVE ENDOCARDITIS Occur in women on prosthetic valves and in those with congenital heart disease Caused by organism such as Strep. Viridians, S. faecalis, S. aureus ECHO may show vegetations on valves There is a high risk of mortality - Treated with appropriate antibiotics after blood culture studies - Beta-blockers such as metoprolol 8 Presentation title 20XX

9. PROPHYLAXIS Routine administration is NOT practiced anymore. Therefore, IE prophylaxis is recommended only for women with high risk (AHA –American heart association ; ACOG- American college of obstetricians and gynecologists) Women with prosthetic valve Prior endocarditis Cyanotic heart disease untreated / treated with prosthetic material or device within previous 6 months or with residual defects at or adjacent to the site of prosthesis For indications such as dental extraction 9 Presentation title 20XX

10. ANTIBIOTIC REGIMEN - In active labor or at membrane rupture Inj. Ampicillin 2g IV/IM single dose + inj. Gentamycin 1.5 mg/kg IV Followed 6hrs. late by Inj. Ampicillin 1g IM/IV or Amoxicillin 2g oral If allergic to penicillin Inj. vancomycin 1g IV over 1-2 hrs. +inj. Gentamycin 1.5 mg/kg IV or Cefazoline or ceftriaxone 1g IV or Clarithromycin or azithromycin 500mg oral or Clindamycin 600mg oral 10 Presentation title 20XX

11. MATERNAL MORTALITY RISK High risk (mortality 25-50%; pregnancy contraindicated) 1. Eisenmenger’s complex 2. Cyanotic heart disease (tetralogy of Fallot) 3. Pulmonary hypertension 4. Hypertrophic obstructive cardiomyopathy 5. NYHA classes III or IV with severe ventricular dysfunction 6. Marfan syndrome with significant aortic root/ aortic valve involvement 7. Acute myocardial infarction 11 Presentation title 20XX

12. Moderate to high mortality (5-15%) Coarctation – uncomplicated Marfan syndrome with normal aortic root Mechanical prosthetic valves Valvular stenosis – classes III and IV Low risk (mortality < 1%) Mild to moderate valvular regurgitation Mitral valve prolapse Small ASD, VSD, PDA Mitral stenosis – classes I and II 12 Presentation title 20XX

13. FETAL COMPLICATIONS EFFECT OF HEART DISEASE ON PREGNANCY Preterm labor, Fetal growth restriction (FGR) and spontaneous miscarriages are more common in cases with tight mitral stenosis, cyanotic heart disease with right-to-left shunt (TOF) and Eisenmenger syndrome due to reduced oxygenation. Incidence of congenital heart disease is high in infants of parents with congenital heart disease . - Marfan syndrome and some hypertrophic cardiomyopathies that are inherited as autosomal dominant carry a 50% risk of inheritance -Congenital heart diseases such as ASD or VSD , the risk of inheritance ranges from 2-10% 13 Presentation title 20XX

14. Thank you Reference ; Mudaliar and Menon's clinical obstetrics