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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
- 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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