Heart Disease in Pregnancy Quiz

Questions and Answers

What should be done for women with WHO risk class I-II and NYHA I & II?

They require immediate hospitalization in a tertiary center.

They can be managed locally after review by a cardiac specialist. (correct)

They must undergo termination of pregnancy.

They need constant fetal surveillance throughout pregnancy.

What is preferred for women in NYHA/WHO Risk II-III, III & IV regarding delivery?

Vaginal delivery is not suitable and cesarean is preferred.

Wait for natural onset of labour without medical intervention.

Spontaneous labour is advisable regardless of condition.

It is recommended to have a planned delivery. (correct)

For women classified in WHO risk class II-III and NYHA III & IV, what is the recommended follow-up?

Regular consultations with a primary care physician only.

Routine check-ups at a local clinic.

Patient should avoid any cardiovascular assessments.

Follow-up in a tertiary center by a multidisciplinary team. (correct)

What should be included in an individualised pregnancy care plan?

The time, place, and mode of delivery tailored to the woman’s status. Signup and view all the answers

What is the percentage of cardiac disease incidence in pregnancy according to the available data from 2014?

0.45% Signup and view all the answers

What is the main aim for maternal cardiovascular management during pregnancy?

Maintain normal blood pressure and optimize cardiovascular status. Signup and view all the answers

Which physiological change can lead to congestive heart failure during pregnancy?

Increase in cardiac output Signup and view all the answers

What condition is associated with tachycardia in pregnant women with severe mitral stenosis?

Palpitations Signup and view all the answers

What can compression of the inferior vena cava by the uterus lead to?

Venous stasis and hypotensive syndromes Signup and view all the answers

Which of the following conditions worsen with increased preload during pregnancy?

Severe mitral stenosis Signup and view all the answers

After a vaginal delivery, when do haemodynamic changes typically return to pre-pregnant levels?

2-4 weeks Signup and view all the answers

Which type of cardiac disease is characterized by structural heart problems present from birth?

Congenital heart disease Signup and view all the answers

Which of the following is NOT a consequence of the hypercoagulable state during pregnancy?

Decreased risk of thromboembolism Signup and view all the answers

What percentage of total maternal deaths were attributed to cardiac disease between 2009-2011?

15.3% Signup and view all the answers

What condition is classified as high risk due to severe pulmonary hypertension?

Eisenmenger syndrome Signup and view all the answers

In which risk category would a patient with corrected transposition without other defects be classified?

Low risk Signup and view all the answers

What is the ideal setting for managing high-risk cardiac patients?

Tertiary center with a multidisciplinary approach Signup and view all the answers

Which family history factor is pertinent for risk assessment in cardiac disease?

History of cardiac murmurs or sudden death Signup and view all the answers

Which of the following symptoms is not typically associated with normal findings in pregnancy that may mimic cardiac disease?

Severe chest pain Signup and view all the answers

Which of the following is a common recommendation during preconception counseling?

A review of past pregnancies Signup and view all the answers

What common condition is associated with a risk of recurrent congenital heart lesions in the fetus?

Parents with congenital heart disease Signup and view all the answers

What is the primary physical examination finding that should be taken into account in patients with suspected heart disease during pregnancy?

Assessment of heart rate and blood pressure manually Signup and view all the answers

What is the approximate increase in blood volume during pregnancy at its peak?

40-50% Signup and view all the answers

What change in blood pressure is typically observed during the second trimester of pregnancy?

Significant decrease Signup and view all the answers

When is counseling for pregnancy ideally started for women with cardiac disease?

At puberty Signup and view all the answers

What physiological change occurs initially during pregnancy to contribute to the increase in cardiac output?

Increase in stroke volume Signup and view all the answers

What should be reviewed during preconception counseling for women with treated hypertension?

Anti-hypertensive medications safe in pregnancy Signup and view all the answers

What is the condition that may lead to significant obstetric complications in pregnant women with cardiac disease?

Supine hypotension syndrome Signup and view all the answers

In what time frame should women planning to conceive undergo preconception counseling?

6 months before conception Signup and view all the answers

What are the conditions under which a Caesarean section should be performed?

Obstetric indications and heart failure (NYHA III & IV) Signup and view all the answers

Which monitoring technique is crucial during the intrapartum period?

Continuous fetal monitoring and maternal hemodynamic status Signup and view all the answers

What is the recommended position for a laboring patient to avoid aortocaval compression?

Lateral decubitus position Signup and view all the answers

What is the minimum recommended length of hospital stay postpartum for monitoring?

3-5 days Signup and view all the answers

Which of the following is NOT part of the management strategy for patients with heart disease in pregnancy?

Elective caesarean for all patients Signup and view all the answers

Study Notes

Learning Outcomes

Define physiological cardiovascular changes during pregnancy.
Understand the importance of preconception and genetic counseling for patients with heart diseases.
List risk assessment criteria and levels of care required for patients with heart diseases during pregnancy.
Outline management strategies for antepartum, intrapartum, and postpartum phases for heart disease patients.

Epidemiology

Cardiac disease incidence in Malaysia: 0.55% (2013) and 0.45% (2014).
Contributed to 51% of indirect maternal deaths (2009-2011) and 15.3% of total maternal deaths.

Physiological Changes in the Cardiovascular System

Increased cardiac output may lead to congestive cardiac failure in patients with limited cardiac reserve.
Increased preload and/or ventricular dysfunction can worsen conditions, particularly in patients with obstructive lesions.
Tachycardia can cause palpitations, impairing ventricular filling in severe mitral stenosis cases.
Hypercoagulable state raises risk of thromboembolism.
Compression of inferior vena cava can lead to venous stasis and supine hypotensive syndrome.

Blood Volume and Cardiac Output

Blood volume increases 40-50%, peaking at 32-36 weeks of pregnancy before plateauing.
Cardiac output increases by 30-50%, peaking at 20-24 weeks; initially due to stroke volume, then heart rate.
Systemic vascular resistance and blood pressure typically decrease, especially in the second trimester.
Increased pulmonary blood flow with unchanged pulmonary artery pressure.

Preconception and Genetic Counseling

Counseling should start at puberty and emphasized by age 16-18 and before marriage.
Assessment of exercise capacity, past cardiac events, and potential fetotoxic medications is crucial.
Review comorbidities (e.g., obesity, hypertension) and recommend lifestyle changes including cessation of smoking and alcohol.
Folic acid supplementation suggested 3-6 months before conception.

Types of Cardiac Disease

Includes congenital heart disease, rheumatic heart disease, valvular heart disease, myocardial infarction, arrhythmias, and peripartum cardiomyopathy.

Risk Assessment and Levels of Care

Low Risk: Uncomplicated septal defects, aortic/mitral regurgitation, and mild pulmonary stenosis.
Moderate Risk: Patients with prosthetic valves on anticoagulant therapy and coarctation of the aorta.
High Risk: Conditions like Eisenmenger syndrome, uncorrected cyanotic heart disease, and severe valvular diseases.
High-risk patients should be managed in tertiary care centers, while low-risk can be seen in primary care settings.

Assessment and Risk Stratification

Conduct thorough history and clinical examination focusing on cardiovascular symptoms and family history.
Monitor vital signs manually and check oxygen saturation using pulse oximetry.
Recognize normal pregnancy findings that may mimic cardiac conditions (e.g., palpitations, fatigue).

General Principles in Management

Early referral for cardiac assessment and risk evaluation is crucial.
Manage patients with WHO risk classes I-II in local hospitals, but those in class II-III or NYHA III-IV require specialized care.

Antepartum Care

Individualized care plans based on maternal cardiovascular status and fetal well-being.
Medication review for safety during pregnancy and fetal assessments.
Monitor and maintain normal blood pressure.

Intrapartum Management

Continuous monitoring of hemodynamic status, support with oxygen if saturation drops below 95%.
Employ lateral decubitus position to prevent aortocaval compression.
Prefer shorter labor stages to reduce stress on the cardiovascular system.

Postpartum Care

Intensive monitoring for the first few days in HDU/ICU/CCU.
Watch for fluid overload and postpartum hemorrhage.
Provide contraception counseling to prevent unplanned pregnancies.

Summary

Importance of preconception counseling and risk assessment.
Need for comprehensive history and physical examinations.
Awareness of complications of heart disease during pregnancy for both mother and fetus.
Emphasis on antenatal and intrapartum management, alongside contraception strategies for family planning.

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Description

Test your knowledge on the physiological changes in the cardiovascular system during pregnancy. This quiz also covers important counseling and risk assessment for patients with heart diseases in pregnancy. Enhance your understanding of obstetrics and gynecology related to cardiovascular health.