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Flashcards in Cardiac issues in pregnancy Deck (7)
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1

What are the normal cardiac changes in pregnancy?

- 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

2

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

- 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

3

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

- 28-32 weeks gestation
- labour (particularly 3rd stage)
- 12-24 hours postpartum

4

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

- C refer

5

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

- 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)

6

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

- 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)

7

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

- 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)