Summary Effects of Maternal Disease in Pregnancy

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