MANAGEMENT OF CARDIAC

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

Prevention of anemia, infection and hypertension

Clinical and ultra sonographic assessment of fetal growth and well being
Early detection and management of cardiac failure

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

IN BRIEF MANAGEMENT OF LABOUR

Close supervison of labour progress and cardiac status
Antibiotic prophylaxis against bacterial endocarditis
Adequate pain control
To cut short second stage
To avoid ergometrine in third stage of labour
pregnancy and lactation
Pregnancy
Ergometrine has potent uterotonic activity.
Breast-feeding
Ergometrine derivatives are excreted in breast milk but in unknown amounts.
Ergometrine can inhibit prolactin secretion and in turn can suppress lactation,
so its repeated use should be avoided.

MANAGEMENT OF CARDIAC FAILURE

Emergency situation which should be managed immediately
Sudden cardiac failure, in otherwise asymptomatic patient develop sudden cardiac
failure after delivery due to increased intravascular blood volume diverted from routine
and pelvic vessels.
Principle of management same as patient without pregnancy.
Administration of oxygen with patient in propped up position
Intravenous morphine, aminophylline and frusemide administered to reduce pulmonary
edema.
Digoxin is started to improve myocardial efficiency