上海交通大学医学院：《妇产科学》（双语） 29 Medical and Surgical Complications during Pregnancy

Medical and Surgical Complications during Pregnancy I Heart Deseases in Pregnancy

Medical and Surgical Complications during Pregnancy Heart Deseases in Pregnancy

Incidence Heart disease complicates about 1 percent of pregnancies. Component congenital heart disease hematic 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

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

Maternal mortality 0.3 per 10,000 live births Heart disease still significantly contributes to maternal mortality. 5.6-8.5 percent of maternal deaths

• 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 6th week to 32nd week Stroke volume is increased by 20-4090 Resting pulse is increased(by 10-17%0) The changes of anatomic positions heart, diaphragm, uterus. formation of utero-placental circulation

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 6th 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 dematic 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

➢ 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

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

Clinical Classification (con't Class l 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 lv 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

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 (con’t)

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

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:

Symptoms Severe or progressive dyspnea Progressive orthopnea Paroxysmal nocturnal dyspnea Hemoptysis Syncope with exertion Chast pain related to effort or emotion Clinical Findings Cvanosis Clubing of fingers

• 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

Symptoms (con 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

• 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 (con’t)