扬州大学：《妇产科学》课程教学课件（PPT讲稿）12 妊娠合并心脏病 Cardiovascular Complications

Cardiovascular Complications

Cardiovascular Complications

General Consideration. Cause of mother deathThe2ndcause.Incidence1%-4%

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

General ConsiderationAntenatal cardiovascular changesBlood volumeincrease by40%-60%Peaking at 32-34 weeksthe expansion in plasma volume is greaterthan that expansion of red cell massCardiac outputIncreaseby40%-50%Peakingat20-24weeks

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 Consideration3.Blood pressureDecrease in the first trimesterRise to prepregnancy levels in the thirdtrimesterHeart sizeVentricular chamber size is increasedSystolic 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 ConsiderationIntrapartum cardiovascular changesFirst-stage labor300ml-500ml ↑ (each contraction)Cardiac output f (maternal pain, anxiety)2.Second-stage laborLung circulation ↑ (bearing-down efforts toexpelthefetus)Venous return (after fetus is deliveried)Placental circulation is lost (after placenta isdeliveried)

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 Consideration3.PostpartumCirculating blood volume ↑ (Placental circulationislost)Circulating blood volume further ↑ (mobilizationof extravascular fluid into the vascularsystem)

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 ComplicationCongenital heart disease先心：the most frequentLefttorightshunting左向右分流型Atrial septaldefect（ASD）房缺：most commonasymptomatic (most patients);pulmonarybloodflow↑(lesion≥2cm)→pulmonaryhypertension → Eisenmenger's syndrome2)Ventricular septaldefect（VSD）室缺tolerated (smalllesion);left ventricularhypertrophy→ 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 Complication3）Patentductusarteriosus（PDA）动脉导管未闭rare (early surgical repair);hemodynamicconsequence are similar to VSDRighttoleftshunting右向左分流型DTetralogyofFallot法洛氏四联征Pulmonary stenosis, right ventricularhypertrophy,largeventricular septal defectand overriding aortathe most common cyanotic lesion complicatingpregnancy

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 Complication3.Non-shuntingPulmonary stenosisNot usually progressive2)Aortic stenosisrare;its outcome is bad3）Marfan's syndrome (genetic disorder)Myxomatous degeneration of the heart valves;mitral andcystic medial necrosis（囊性中层坏死）oftheaorta（aneurysms动脉瘤）deathrate:4%-50%

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 ComplicationRheumatic heart diseaseMitral stenosis is the most common lesion2. Severe lesion with pulmonary hypertension-pulmonary edema -→ hear failure: terminatethepregnancyHeart disease caused by preeclampsiaLeft heart failure (increased blood pressureand 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)