Cardiovascular Complications

1
Cardiovascular Complications

• Liu Wei
• Department of Ob Gy
• Ren Ji hospital

2
General Consideration

• Cause of mother death
• The 2nd cause
• Incidence
• 1-4

3
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

4
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.

5
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)

6
General Consideration

• Postpartum
• Circulating blood volume?(Placental circulation
  is lost)
• Circulating blood volume further?(mobilization of
  extravascular fluid into the vascular system)

7
Types of Cardiovascular Complication

• Congenital heart disease?? the most frequent
• Left to right shunting??????
• Atrial septal defect (ASD)?? most common
• asymptomatic (most patients) pulmonary
  blood flow?(lesion 2cm2) ? pulmonary
  hypertension ? Eisenmengers syndrome
• Ventricular septal defect (VSD)??
• tolerated (small lesion) left ventricular
  hypertrophy? pulmonary hypertension?
  biventricular hypertrophy

8
Types of Cardiovascular Complication

• Patent ductus arteriosus (PDA)??????
• rare (early surgical repair) hemodynamic
  consequence are similar to VSD
• Right to left shunting??????
• Tetralogy of Fallot??????
• Pulmonary stenosis, right ventricular
  hypertrophy, large ventricular septal defect and
  overriding aorta
• the most common cyanotic lesion complicating
  pregnancy

9
Types of Cardiovascular Complication

• Non-shunting
• Pulmonary stenosis
• Not usually progressive
• Aortic stenosis
• rare its outcome is bad
• Marfans syndrome (genetic disorder)
• Myxomatous degeneration of the heart
  valves mitral and cystic medial necrosis(??????)
  of the aorta (aneurysms???)
• death rate 4-50

10
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)

11
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.

12
Types of Cardiovascular Complication

• Myocarditis ???
• Manifestation arrhythmia????
• Sequelae of myocarditis?????? more common

13
Effects on fetus

• Preterm labor, fetal death, fetal distress
• Drug used
• Inherited problem
• Ventricular septal defect (VSD) 22
• Marfans syndrome 50

14
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 Eisenmengers
  syndrome or arrhythmia
• Functional classification
• Class IIV

15
Diagnosis

• more significant signs
• History palpitation(??), short breath, heart
  disease
• Orthopnea (????), chest pain, expectoration of
  blood (??)
• Cyanosis??, diastolic murmur?????
• Arrhythmia
• Enlargement of heart (chest x-ray film)
• Echocardiogram chamber enlarge, hypertrophy,
  abnormality of valve

16
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)

17
early diagnosis of heart failure

• Palpitation and short breath with less than
  normal activity
• HRgt110, Rgt20 at rest
• Orthopnea at night
• Persistent wet rale in lung

18
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???
• Combined valve disease
• Acute myocarditis

19
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

20
Treatment

• Treatment of heart failure
• Cardiotonic?? digoxin
• Vascular dilation
• Diuretic??
• Caesarean section

21
Treatment

• Intrapartum treatment
• Method of delivery CS
• First stage
• calm down, ataractic(???), oxygen supplement
• Second stage
• Operative vaginal delivery
• Third stage
• Preventing postpartum hemorrhage
• Puerperium
• Preventing infection

22
END