Flashcards in Cardiac issues in pregnancy Deck (7)
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
What are 9 signs/symptoms of cardiac compromise in pregnancy?
- shortness of breath (dyspnoea)
- difficulty breathing when lying down (orthopnoea)
- tachycardia or bradycardia
- chest pain with activity
- peripheral oedema
- abnormal heart sounds
What are the riskiest times for women with heart disease in pregnancy?
- 28-32 weeks gestation
- labour (particularly 3rd stage)
- 12-24 hours postpartum
What is the responsibility of the midwife where a woman presents with a history of cardiovascular disease at commencement of care?
- C refer
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)
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)