Podcast
Questions and Answers
What should be done for women with WHO risk class I-II and NYHA I & II?
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?
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?
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?
What should be included in an individualised pregnancy care plan?
What is the percentage of cardiac disease incidence in pregnancy according to the available data from 2014?
What is the percentage of cardiac disease incidence in pregnancy according to the available data from 2014?
What is the main aim for maternal cardiovascular management during pregnancy?
What is the main aim for maternal cardiovascular management during pregnancy?
Which physiological change can lead to congestive heart failure during pregnancy?
Which physiological change can lead to congestive heart failure during pregnancy?
What condition is associated with tachycardia in pregnant women with severe mitral stenosis?
What condition is associated with tachycardia in pregnant women with severe mitral stenosis?
What can compression of the inferior vena cava by the uterus lead to?
What can compression of the inferior vena cava by the uterus lead to?
Which of the following conditions worsen with increased preload during pregnancy?
Which of the following conditions worsen with increased preload during pregnancy?
After a vaginal delivery, when do haemodynamic changes typically return to pre-pregnant levels?
After a vaginal delivery, when do haemodynamic changes typically return to pre-pregnant levels?
Which type of cardiac disease is characterized by structural heart problems present from birth?
Which type of cardiac disease is characterized by structural heart problems present from birth?
Which of the following is NOT a consequence of the hypercoagulable state during pregnancy?
Which of the following is NOT a consequence of the hypercoagulable state during pregnancy?
What percentage of total maternal deaths were attributed to cardiac disease between 2009-2011?
What percentage of total maternal deaths were attributed to cardiac disease between 2009-2011?
What condition is classified as high risk due to severe pulmonary hypertension?
What condition is classified as high risk due to severe pulmonary hypertension?
In which risk category would a patient with corrected transposition without other defects be classified?
In which risk category would a patient with corrected transposition without other defects be classified?
What is the ideal setting for managing high-risk cardiac patients?
What is the ideal setting for managing high-risk cardiac patients?
Which family history factor is pertinent for risk assessment in cardiac disease?
Which family history factor is pertinent for risk assessment in cardiac disease?
Which of the following symptoms is not typically associated with normal findings in pregnancy that may mimic cardiac disease?
Which of the following symptoms is not typically associated with normal findings in pregnancy that may mimic cardiac disease?
Which of the following is a common recommendation during preconception counseling?
Which of the following is a common recommendation during preconception counseling?
What common condition is associated with a risk of recurrent congenital heart lesions in the fetus?
What common condition is associated with a risk of recurrent congenital heart lesions in the fetus?
What is the primary physical examination finding that should be taken into account in patients with suspected heart disease during pregnancy?
What is the primary physical examination finding that should be taken into account in patients with suspected heart disease during pregnancy?
What is the approximate increase in blood volume during pregnancy at its peak?
What is the approximate increase in blood volume during pregnancy at its peak?
What change in blood pressure is typically observed during the second trimester of pregnancy?
What change in blood pressure is typically observed during the second trimester of pregnancy?
When is counseling for pregnancy ideally started for women with cardiac disease?
When is counseling for pregnancy ideally started for women with cardiac disease?
What physiological change occurs initially during pregnancy to contribute to the increase in cardiac output?
What physiological change occurs initially during pregnancy to contribute to the increase in cardiac output?
What should be reviewed during preconception counseling for women with treated hypertension?
What should be reviewed during preconception counseling for women with treated hypertension?
What is the condition that may lead to significant obstetric complications in pregnant women with cardiac disease?
What is the condition that may lead to significant obstetric complications in pregnant women with cardiac disease?
In what time frame should women planning to conceive undergo preconception counseling?
In what time frame should women planning to conceive undergo preconception counseling?
What are the conditions under which a Caesarean section should be performed?
What are the conditions under which a Caesarean section should be performed?
Which monitoring technique is crucial during the intrapartum period?
Which monitoring technique is crucial during the intrapartum period?
What is the recommended position for a laboring patient to avoid aortocaval compression?
What is the recommended position for a laboring patient to avoid aortocaval compression?
What is the minimum recommended length of hospital stay postpartum for monitoring?
What is the minimum recommended length of hospital stay postpartum for monitoring?
Which of the following is NOT part of the management strategy for patients with heart disease in pregnancy?
Which of the following is NOT part of the management strategy for patients with heart disease in pregnancy?
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.
