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Click to edit Master title,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Medical and Surgical Complications during Pregnancy,Heart Deseases in Pregnancy,Incidence,Heart disease complicates about 1 percent of pregnancies.,Component,congenital heart disease,rheumatic heart disease,hypertensive heart disease,other varieties(inclued:pregnancy-induced hypertension,thyroid,coronary,syphilitic,and kyphoscoliotic cardiac,disease),idiopathic cardiomyopathy(perinatal cardiomyopathy),isolated myocarditis,various forms of heart block,0.3 per 10,000 live births,Heart disease still significantly contributes to,maternal mortality.,5.6-8.5 percent of maternal deaths,Maternal mortality,Effect of pregnancy on heart disease,The pregnant period,Cardiac output is increased by as much as 30-50 percent,almost half of the total increase has occurred by 8,weeks,and it is maximized by mid pregnancy.,Total blood volume is increased about 35%.,from 6,th,week to 32nd week,Stroke volume is increased by 20-40%.,Resting pulse is increased(by 10-17%),The changes of anatomic positions,heart,diaphragm,uterus.,formation of utero-placental circulation,Labor and delivery,Consumption of energy and oxygen is further increased.,Labor is increased maternal cardiac burdens.,Expulsion of the fetus and placenta produce a drematic,hemodynamic changes.,The puerperium,After delivery of the fetus and placenta,during 1-2 days,great amont of blood return into the systemic circulation,and great amont of fluid from intertissue space return to,the systemic circulation,increase cardiac burdens again.,32-34 gestational weeks,during the labor and delivery,and early postpartum period(1-3 days)are the most,danger time for pregnant women with heart disease.It,is easy development heart failure.,Clinical Classification,(,By the New York Heart Association),Class I,Uncompromised:,Patients with cardiac disease and no limitation of physical activity.They do not have symptoms of cardiac insufficiency,nor do they experience anginal pain.,Class II,Slightly compromised:,Patients with cardiac disease and slight limitation of physical activity.These women are comfortable at rest,but if ordinary physical activity is undertaken,discomfort results in the form of excessive fatigue,palpitation,dyspnea,or anginal pain.,Class III,Markedly compromised:,Patients with cardiac disease and marked limitation of physical activity.They are comfortable at rest,but less than ordinary physical activity causes discomfort by excessive fatigue,palpitation,dyspnea,or anginal pain.,Class IV,Severely compromised:,Patients with cardiac disease and inability to perform any physical activity without discomfort.Symptoms of cardiac insufficiency or angina may development at rest,and if any physical activity is undertaken,discomfort is increased.,Clinical Classification,(cont),Diagnosis of heart disease,Many of the physiological changes of normal pregnancy tend to make the diagnosis of heart disease more difficult.,Disease history,Symptoms,and,Clinical Findings,Listed in here symptoms and clinical findings may indicate heart disease:,Severe or progressive dyspnea,Progressive orthopnea,Paroxysmal nocturnal dyspnea,Hemoptysis,Syncope with exertion,Chast pain related to effort or emotion,Clinical Findings,Cyanosis,Clubing of fingers,Symptoms,Persistent neck vein distension,Systolic murmur greater than grade 3/6,Diastolic murmur,Cardiomegaly,Sustained arrhythmia,Persistent split second sound,Criteria for pulmonary hypertension,Left parasternal lift,Loud P2,Symptoms,(cont),Conventional tests,Electrocardiography,Ecocardiography,Chast X-ray,Diagnosis of early heart failure during pregnancy,Dyspnea,palpitation at slight physical activity.,Resting pulse larger than 110 beats per minute.,Paroxysmal nocturnal dyspnea.,Rale in lower lungs,Prognosis,The likelihood of a favorable outcome for the mother,with heart disease depends upon the,(1)functional cardiac capacity,(2)other complications that further increase cardiac load,(3)quality of medical care provided.,Counseling(Preconceptional counceling).,(to decide the pregnancy should be continued),Intensive pregnatal care.,Active prevent factors increasing cardiac,functional load.,(such as respiratory tract infection,anemia and pregnancy-induced hypertension),Management,General management,Monitoring the vital signs,Sedatives and analgesic,Shortening the second stage of labor,(by forceps)(Classes I and II),Indications of CS(cesarean section),(Class III or more,obstetric indications,),Management during labor and delivery,Bring pressure to bear on the upper abdomen,Bed rest,Monitoring the vital signs,Breast feeding(Classes I and II)and,artificial feeding(Classes III or IV),Management or early puerperium,Medical and Surgical Complications during Pregnancy,Acute Viral Hepatitis,Hepatitis is the most common serious liver disease,encountered in pregnant women.,There are at least five distinct types of viral hepatitis:,hepatitis A;hepatitis B;h
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