上海交通大学医学院：《妇产科学》（双语） 2 Cardiovascular Complications

Cardiovascular Complications Liu wei Department of ob gy Ren Ji hospital

Cardiovascular Complications Liu Wei Department of Ob & Gy Ren Ji hospital

General Consideration Cause of mother death The 2nd cause Incidence

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

General Consideration Antenatal cardiovascular changes 1. Blood volume increase by 40%0-60% Peaking at 32-34 weeks the expansion in plasma volume is greater than that expansion of red cell mass. 2. Cardiac output Increase by 4096-50 Peaking at 20-24 weeks

General Consideration • Antenatal cardiovascular changes 1. 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. 2. Cardiac output Increase by 40%-50% Peaking at 20-24 weeks

General Consideration 3. Blood pressure Decrease in the first trimester Rise to prepregnancy levels in the third trimester 4. Heart size Ventricular chamber size is increased Systolic function is unchanged

General Consideration 3. Blood pressure Decrease in the first trimester Rise to prepregnancy levels in the third trimester 4. Heart size Ventricular chamber size is increased Systolic function is unchanged

General Consideration Intrapartum cardiovaseular changes 1. First-stage labor 300ml -500ml t(each contraction) Cardiac output t(maternal pain, anxiety) 2. Second-stage labor Lung circulation f(bearing-down efforts to expel the fetus) Venous return,(after fetus is deliveried) Placental circulation is lost(after placenta is deliveried

General Consideration • Intrapartum cardiovascular changes 1. First-stage labor 300ml –500ml↑(each contraction) Cardiac output↑(maternal pain, anxiety) 2. 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)

General Consideration 3. Postpartum Circulating blood volume t(Placental circulation is lost) Circulating blood volume further f(mobilization of extravascular fluid into the vascular system)

General Consideration 3. Postpartum Circulating blood volume↑(Placental circulation is lost) Circulating blood volume further↑(mobilization of extravascular fluid into the vascular system)

Types of Cardiovascular Complication Congenital heart disease先心: the most frequent 1. Left to right shunting左向右分流型 1) Atrial septal defect(ASD)房缺: most common asymptomatic (most patients); pulmonary blood fow↑(eson≥2cm2)→ pulmonary hypertension- Eisenmenger's syndrome 2) Ventricular septal defect(VSD)室缺 tolerated(small lesion); left ventricular hypertrophy- pulmonary hypertension biventricular hypertrophy

Types of Cardiovascular Complication • Congenital heart disease先心: the most frequent 1. Left to right shunting左向右分流型 1) Atrial septal defect (ASD)房缺: most common asymptomatic (most patients); pulmonary blood flow↑(lesion ≥2cm2 ) → pulmonary hypertension → Eisenmenger’s syndrome 2) Ventricular septal defect (VSD)室缺 tolerated (small lesion); left ventricular hypertrophy→ pulmonary hypertension→ biventricular hypertrophy

Types of Cardiovascular Complication 3) Patent ductus arteriosus(PDA)动脉导管未闭 rare(early surgical repair); hemodynamic consequence are similar to VSD 2. Right to left shunting右向左分流型 1) Tetralogy of Fallot法洛氏四联征 Pulmonary stenosis, right ventricular hypertrophy, large ventricular septal defect and overriding aorta A the most common cyanotic lesion complicating pregnancy

Types of Cardiovascular Complication 3) Patent ductus arteriosus (PDA)动脉导管未闭 rare (early surgical repair); hemodynamic consequence are similar to VSD 2. Right to left shunting右向左分流型 1) Tetralogy of Fallot法洛氏四联征 Pulmonary stenosis, right ventricular hypertrophy, large ventricular septal defect and overriding aorta the most common cyanotic lesion complicating pregnancy

Types of Cardiovascular Complication 3. Non-shunting Pulmonary stenosis Not usually progressive 2) Aortic stenosis rare: its outcome is bad 3) Marfan's syndrome(genetic disorder MyXomatous degeneration of the heart valves mitral and cystic medial necrosis(囊性中层 坏死) of the aorta(aneurysms动脉瘤) death rate: 496-50%0

Types of Cardiovascular Complication 3. Non-shunting 1) Pulmonary stenosis Not usually progressive 2) Aortic stenosis rare; its outcome is bad 3) Marfan’s syndrome (genetic disorder) Myxomatous degeneration of the heart valves; mitral and cystic medial necrosis（囊性中层 坏死） of the aorta (aneurysms动脉瘤) death rate: 4%-50%

Types of Cardiovascular Complication Rheumatic heart disease 1. Mitral stenosis is the most common lesion 2. 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)

Types of Cardiovascular Complication • Rheumatic heart disease 1. Mitral stenosis is the most common lesion. 2. 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)