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Cardiovascular Disease in Pregnancy

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Cardiovascular Disease in Pregnancy


New York Heart Association classification

  • Class 1
    • no symptoms
    • signs of cardiac damage present
    • undertake all physical activities
    • no additional treatment needed
  • Class 2
    • comfortable at rest
    • ordinary physical activities cause fatigue, palpitations, dyspnoea
    • do not require treatment but if social circumstances unfavourable then admit
  • Class 3
    • less than ordinary physical activity causes dyspnoea and fatigue
    • patient comfortable at rest
    • most should be admitted for rest
  • Class 4
    • seriously ill
    • breathless even when resting
    • admission mandatory

Management

  • avoid predisposing factors
    • anaemia
    • infections
      • UTIs
    • hypertension
  • treat heart failure vigorously

During childbirth

  • prevent compression of aorta
    • nurse on side or well propped up
  • check fluid balance and pulse rate
  • digoxin if heart rate >110bpm between contractions
  • prophylactic antibiotics from onset on labour until 5 puerperal days
  • rectify delay in second stage labour by Forceps Delivery / Ventouse delivery
  • Syntometrine safe unless in Heart Failure

Puerperal

  • monitor closely for 24-48 hours
  • bed rest for 2 days
  • keep in hospital for 7 days
 

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