Cardiac issues in pregnancy Flashcards

1
Q

What are the normal cardiac changes in pregnancy?

A
  • 40% increase in cardiac output
  • 20% increase in stroke volume
  • 40% increased blood volume (all peak 20-24/40)
  • increased heart rate (peaks in 3rd trimester)
  • decreased total peripheral resistance due to vasodilation (throughout)
  • decreased blood pressure in first and second trimester
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 9 signs/symptoms of cardiac compromise in pregnancy?

A
  • fatigue
  • shortness of breath (dyspnoea)
  • difficulty breathing when lying down (orthopnoea)
  • dysrhythmias
  • tachycardia or bradycardia
  • chest pain with activity
  • peripheral oedema
  • abnormal heart sounds
  • thromboembolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the riskiest times for women with heart disease in pregnancy?

A
  • 28-32 weeks gestation
  • labour (particularly 3rd stage)
  • 12-24 hours postpartum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the responsibility of the midwife where a woman presents with a history of cardiovascular disease at commencement of care?

A
  • C refer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What antepartum considerations are important in the care of a woman with cardiac disease in pregnancy?

A
  • multidisciplinary collaborative care
  • preconception counselling
  • early referral to tertiary centre
  • baseline evaluation (ECG)
  • ultrasounds for screening for fetal cardiac abnormalities
  • increased frequency of antenatal care
  • birth planning
  • importance of rest (esp in T3)
  • prevent anaemia
  • screening for asymptomatic bacteriuria (increased risk of pyelonephritis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What intrapartum considerations are important in the care of a woman with cardiac disease in pregnancy?

A
  • notify appropriate personell
  • collaborative care
  • vaginal birth has lowest risks
  • pain relief often recommended (esp epidural, timing with thromboprophylaxis)
  • additional observations
  • management of fluid balance
  • oxygen if required
  • position in labour (left lateral, sitting)
  • fetal monitoring
  • antibiotic prophylaxis (at higher risk of infections)
  • length and managment of second stage
  • active management of third stage (not ergometrine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What postpartum considerations are important in the care of a woman with cardiac disease in pregnancy?

A
  • increased observations, high risk for several days
  • thromboprophylaxis (stockings & early ambulation)
  • length of postpartum stay
  • encourage breastfeeding, rest, signs of mastitis, bottle feeding may be indicated in some women
  • contraception, guidance on future pregnancies
  • health follow up (6 weeks, 6 months if concerns and then usual care)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly