Effects ofe Matternaatt Disseatse sa Prnenaataci
CARDIAC DISEASE
Prnofnaofsss
Matternaatt mofrntattsti atssofcsatted wsth specsfc catrndsatc dsseatse:
Group 1 <5% maternal mortality rate ASDi/VSDi/PDiA
Tetrnattofni ofe Fatttoft (surnnscattti cofrnrnected)
Bsof-Prnofsthetc vattve
Putmofaatrni/Bscuspsd vattve dsseatse
Mstrnatt steaofsss (NYHA 1-2)
Group 2 5-10% maternal mortality rate Mstrnatt steaofsss (NYHA 3-4)
Aofrntc steaofsss
Tetrnattofni ofe Fatttoft (aoft cofrnrnected)
Prnevsofus MI
Matrneata’s (aofrnmatt atofrntat)
Aofrntc cofatrnctattofa (aof vattve savoftvemeat)
Group 3 25-30% maternal mortality rate Aofrntc cofatrnctattofa (+ vattve savoftvemeat)
Matrneata’s (atofrntc savoftvemeat)
Mstrnatt steaofsss + AF
PHTN
Arntfcsatt vattve
Geaernatt Mataatnemeat
- Allow spontaneous labour at term – Oati schedute saductofa sa wofmea whof rnequsrne savatssve catrndsatc mofastofrnsan
- Adequate pain relief - rnensofaatt ataatesthessat ss prneeernrned
- Left lateral posiioning – tof atvofsd IVC cofmprnesssofa thus matxsmsse eofetatt atad matternaatt btofofd fofw
- Monitoring - O2 satts, ECG, fusd satatke/UO, ~savatssve hatemofdiaatmsc mofastofrnsan (se NYHA >3)
Specsfc catrndsatc cofadstofas
Effect Management
ARRHYTMIAS Pattpstattofas atrne aofrnmatt but atrnrnhithmsats shofutd be Iax: 12 teatd ECG, TFT, Hb, 24 hofurns ECG,
savestnatted Echof
Rssks tof eofetus: LMWH or Aspirin atrne satee atatcofatns
Cofaneastatt heatrnt dsseatse Metoprolol ofrn Atenolol atrne the
Ptatceatatt sasufficseaci (se matternaatt ciataofsss) prneeernrned B-btofckerns
Prneternm detsverni Digoxin crnofsses ptatceatat but aoft
ternattofneasc
Adenosine eofrn SVTs ss satee
DC cardioversion ss satee
NOT: Amsofdatrnofae, Watrneatrnsa
HEART FAILURE Matternaatt heattth tatkes prnsofrnsti B-blockers (satee)
Furosemide (but cofutd catuse eofetatt
thrnofmbofcitofpeasat)
Digoxin (crnofsses ptatceatat but aof hatrnm)
LMWH - eofrn tofw veatrnscutatrn euactofa
NOT: ACE inhibitors (but mati be durnsan
brneatstfeedsan se matternaatt heattth
cofmprnofmssed).
INFECTIVE Rssk tof eofetus: Prnofphitatxss ofati aeeded se:
ENDOCARDITIS - 2-3% rnssk ofe bacteraemia sa vatnsaatt - Prnofsthetc vattve
detsverni - Prnsofrn IE
- Heatrnt trnatasptatat
- Uarnepatsrned cofaneastatt heatrnt
dsseatse
Rensmea:
- Ampicillin + Gentamycin
- 30msas beeofrne/att tatbofurn
- Repeatt TDiS uatt detsverned
PROSTHETIC VALVES Rssks tof mofthern: The ONLY exceptofa eofrn Warfarin sa
- Emboftszattofa prnenaataci (beaeft ofutwesnhs rnssk)
- Vattve diseuactofa ANBX – prnofphitatxss atnatsast IE
CARDIAC DISEASE
Prnofnaofsss
Matternaatt mofrntattsti atssofcsatted wsth specsfc catrndsatc dsseatse:
Group 1 <5% maternal mortality rate ASDi/VSDi/PDiA
Tetrnattofni ofe Fatttoft (surnnscattti cofrnrnected)
Bsof-Prnofsthetc vattve
Putmofaatrni/Bscuspsd vattve dsseatse
Mstrnatt steaofsss (NYHA 1-2)
Group 2 5-10% maternal mortality rate Mstrnatt steaofsss (NYHA 3-4)
Aofrntc steaofsss
Tetrnattofni ofe Fatttoft (aoft cofrnrnected)
Prnevsofus MI
Matrneata’s (aofrnmatt atofrntat)
Aofrntc cofatrnctattofa (aof vattve savoftvemeat)
Group 3 25-30% maternal mortality rate Aofrntc cofatrnctattofa (+ vattve savoftvemeat)
Matrneata’s (atofrntc savoftvemeat)
Mstrnatt steaofsss + AF
PHTN
Arntfcsatt vattve
Geaernatt Mataatnemeat
- Allow spontaneous labour at term – Oati schedute saductofa sa wofmea whof rnequsrne savatssve catrndsatc mofastofrnsan
- Adequate pain relief - rnensofaatt ataatesthessat ss prneeernrned
- Left lateral posiioning – tof atvofsd IVC cofmprnesssofa thus matxsmsse eofetatt atad matternaatt btofofd fofw
- Monitoring - O2 satts, ECG, fusd satatke/UO, ~savatssve hatemofdiaatmsc mofastofrnsan (se NYHA >3)
Specsfc catrndsatc cofadstofas
Effect Management
ARRHYTMIAS Pattpstattofas atrne aofrnmatt but atrnrnhithmsats shofutd be Iax: 12 teatd ECG, TFT, Hb, 24 hofurns ECG,
savestnatted Echof
Rssks tof eofetus: LMWH or Aspirin atrne satee atatcofatns
Cofaneastatt heatrnt dsseatse Metoprolol ofrn Atenolol atrne the
Ptatceatatt sasufficseaci (se matternaatt ciataofsss) prneeernrned B-btofckerns
Prneternm detsverni Digoxin crnofsses ptatceatat but aoft
ternattofneasc
Adenosine eofrn SVTs ss satee
DC cardioversion ss satee
NOT: Amsofdatrnofae, Watrneatrnsa
HEART FAILURE Matternaatt heattth tatkes prnsofrnsti B-blockers (satee)
Furosemide (but cofutd catuse eofetatt
thrnofmbofcitofpeasat)
Digoxin (crnofsses ptatceatat but aof hatrnm)
LMWH - eofrn tofw veatrnscutatrn euactofa
NOT: ACE inhibitors (but mati be durnsan
brneatstfeedsan se matternaatt heattth
cofmprnofmssed).
INFECTIVE Rssk tof eofetus: Prnofphitatxss ofati aeeded se:
ENDOCARDITIS - 2-3% rnssk ofe bacteraemia sa vatnsaatt - Prnofsthetc vattve
detsverni - Prnsofrn IE
- Heatrnt trnatasptatat
- Uarnepatsrned cofaneastatt heatrnt
dsseatse
Rensmea:
- Ampicillin + Gentamycin
- 30msas beeofrne/att tatbofurn
- Repeatt TDiS uatt detsverned
PROSTHETIC VALVES Rssks tof mofthern: The ONLY exceptofa eofrn Warfarin sa
- Emboftszattofa prnenaataci (beaeft ofutwesnhs rnssk)
- Vattve diseuactofa ANBX – prnofphitatxss atnatsast IE
