Cardiovascular complications
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Cardiovascular Complications. Liu Wei Department of Ob & Gy Ren Ji hospital. General Consideration. Cause of mother death The 2 nd cause Incidence 1%-4%. General Consideration. Antenatal cardiovascular changes Blood volume increase by 40%-60%

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Cardiovascular Complications

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Cardiovascular complications

Cardiovascular Complications

Liu Wei

Department of Ob & Gy

Ren Ji hospital


General consideration

General Consideration

  • Cause of mother death

    The 2nd cause

  • Incidence

    1%-4%


General consideration1

General Consideration

  • Antenatal cardiovascular changes

  • Blood volume

    increase by 40%-60%

    Peaking at 32 –34 weeks

    the expansion in plasma volume is greater than that expansion of red cell mass.

  • Cardiac output

    Increase by 40%-50%

    Peaking at 20-24 weeks


General consideration2

General Consideration

  • Blood pressure

    Decrease in the first trimester

    Rise to prepregnancy levels in the third trimester

  • Heart size

    Ventricular chamber size is increased

    Systolic function is unchanged.


General consideration3

General Consideration

  • Intrapartum cardiovascular changes

  • First-stage labor

    300ml –500ml↑(each contraction)

    Cardiac output↑(maternal pain, anxiety)

  • Second-stage labor

    Lung circulation↑(bearing-down efforts to expel the fetus)

    Venous return↓(after fetus is deliveried)

    Placental circulation is lost (after placenta is deliveried)


General consideration4

General Consideration

  • Postpartum

    Circulating blood volume↑(Placental circulation is lost)

    Circulating blood volume further↑(mobilization of extravascular fluid into the vascular system)


Types of cardiovascular complication

Types of Cardiovascular Complication

  • Congenital heart disease先心: the most frequent

  • Left to right shunting左向右分流型

  • Atrial septal defect (ASD)房缺: most common

    asymptomatic (most patients); pulmonary blood flow↑(lesion ≥2cm2) → pulmonary hypertension → Eisenmenger’s syndrome

  • Ventricular septal defect (VSD)室缺

    tolerated (small lesion); left ventricular hypertrophy→ pulmonary hypertension→ biventricular hypertrophy


Types of cardiovascular complication1

Types of Cardiovascular Complication

  • Patent ductus arteriosus (PDA)动脉导管未闭

    rare (early surgical repair); hemodynamic consequence are similar to VSD

  • Right to left shunting右向左分流型

  • Tetralogy of Fallot法洛氏四联征

    Pulmonary stenosis, right ventricular hypertrophy, large ventricular septal defect and overriding aorta

    the most common cyanotic lesion complicating pregnancy


Types of cardiovascular complication2

Types of Cardiovascular Complication

  • Non-shunting

  • Pulmonary stenosis

    Not usually progressive

  • Aortic stenosis

    rare; its outcome is bad

  • Marfan’s syndrome (genetic disorder)

    Myxomatous degeneration of the heart valves; mitral and cystic medial necrosis(囊性中层坏死)of the aorta (aneurysms动脉瘤)

    death rate: 4%-50%


Types of cardiovascular complication3

Types of Cardiovascular Complication

  • Rheumatic heart disease

  • Mitral stenosis is the most common lesion.

  • Severe lesion with pulmonary hypertension→ pulmonary edema → hear failure: terminate the pregnancy

  • Heart disease caused by preeclampsia

    Left heart failure (increased blood pressure and cardiac muscle ischemia)


Types of cardiovascular complication4

Types of Cardiovascular Complication

  • Peripartum cardiomyopathy

  • Congestive cardiomyopathy (during the late stage of pregnancy (3 months) or within the first 6 months postpartum)

  • Absence of other causes of heart failure

  • Its etioloty is uncertain

  • Manifestations: symptoms caused by heart failure and embolism

  • The risk of maternal mortality is 30%-50%.


Types of cardiovascular complication5

Types of Cardiovascular Complication

  • Myocarditis 心肌炎

  • Manifestation: arrhythmia心律失常

  • Sequelae of myocarditis心肌炎后遗症: more common


Effects on fetus

Effects on fetus

  • Preterm labor, fetal death, fetal distress

  • Drug used

  • Inherited problem

    Ventricular septal defect (VSD): 22%

    Marfan’s syndrome: 50%


Diagnosis

Diagnosis

  • Etiology diagnosis

    congenital or rheumatic or preeclampsia or peripartum cardiomyopathy

  • Anatomy diagnosis

    ASD or VSD or PDA or mitral stenosis or mitral regurgitation

  • Pathophysiology diagnosis

    pulmonary hypertension or Eisenmenger’s syndrome or arrhythmia

  • Functional classification

    Class: I—IV


Diagnosis1

Diagnosis

  • more significant signs

  • History: palpitation(心悸), short breath, heart disease

  • Orthopnea (端坐呼吸), chest pain, expectoration of blood (咯血)

  • Cyanosis紫绀, diastolic murmur舒张期杂音

  • Arrhythmia

  • Enlargement of heart (chest x-ray film)

  • Echocardiogram: chamber enlarge, hypertrophy, abnormality of valve


Functional classification of heart disease

Functional classification of heart disease

  • New York Heart Association (NYHA)

  • Class I: asymptomatic

  • Class II: symptoms with normal activity

  • Class III: symptoms with less than normal activity

  • Class IV: symptoms at rest

  • Revised guideline

    According to the result of objective testing (chest x-ray, EKG, echocardiogram)


Early diagnosis of heart failure

early diagnosis of heart failure

  • Palpitation and short breath with less than normal activity

  • HR>110, R>20 at rest

  • Orthopnea at night

  • Persistent wet rale in lung


Judgment of safety of pregnancy

Judgment of safety of pregnancy

  • Conception should be prevented if:

  • Severe heart disease

  • Functional classification: class III-IV

  • History of heart failure

  • Pulmonary hypertension

  • Right to left shunting

  • Severe arrhythmia

  • rheumatic fever风湿热

  • Combined valve disease

  • Acute myocarditis


Treatment

Treatment

  • Antenatal treatment

  • Termination of pregnancy:

    Terminate before 12 weeks (cases not suitable to pregnancy)

  • Antenatal supervise: regular and intensive and early (early pregnancy)

  • Prevention of heart failure

  • sufficient rest

  • weigh control

  • preventing infection, correcting anemia and arrhythmia


Treatment1

Treatment

  • Treatment of heart failure

  • Cardiotonic强心: digoxin

  • Vascular dilation

  • Diuretic利尿

  • Caesarean section


Treatment2

Treatment

  • Intrapartum treatment

  • Method of delivery: CS

  • First stage

    calm down, ataractic(镇静剂), oxygen supplement

  • Second stage

    Operative vaginal delivery

  • Third stage

    Preventing postpartum hemorrhage

  • Puerperium

    Preventing infection


Cardiovascular complications

END


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