baligh

1. Heart diseases with pregnancy

2. Heart diseases with pregnancy

3. Heart diseases with pregnancy

4. Incidence: 1-3 %of all pregnancies ( 90 % are rheumatic ) : Mitral

5. Classification : 1.NYHA: functional impairment Class I : Asymptomatic ClassII : Symptomatic with heavy exertion Class III : Symptomatic with light exertion Class IV: Symptomatic at rest

6. Classification : 2- ACOGClassification : according to maternal mortality : Group I : MS. NYHA I,II-> 0-1 % ASD , VSD , PDA Group II: MS. NYHA III,IV AS, Aortic coarctation , MS with AF Artificial valve 5-15 % GroupIII: Pulmonary HTN Aortic coarctation with valve involvement :25 – 50 %

7. Pregnancy and heart disease relationship

8. ☺ Effect of pregnancy on heart disease : » ↑ cardiac work due to Haemodynamic changes »Heart Failure esp. during : 1. Pregnancy28 – 32 wks 2. Labour-> 1st stage : Uterine cont. -> 2nd stage : Straining -> 3rd stage : Placental delivery 3. puerperium: 4th , 5th day : infection

9. ☺ Effect of heart disease on pregnancy : ♠ Mother : › Pregnancy -> polyhydramnios › Labour-> Preterm labour › Puerperium: -> PPH -> puerperal sepsis -> Mortality 10 % ♠ Fetus : › Abortion › Cong. Anomalies -> Cardiac › IUGR › IUFD

10. Diagnosis

11. A – Clinical : ♠ History : 1.Past Hx. Of Cardiac troubles . 2.Complaint : › Lung congestion ›Sys. Congestion ›Low COP ›Degree of functional impairment ( NYHA )

12. A – Clinical : ♠ Examination : 1. General : › Cyanosis , blue clubbing, congested neck veins , oedmalower limb › Lung -> basal crepitations › Heart -> murmer , gallop 2. Abdominal : › Fundallevel ( gest. Age )

13. B – Investigations : ♠ ECG ♠ Echo ♠ Chest X- ray

14. Management

15. ☺ Pre-conceptional Care : ♠ CalssI, II : -> Allow to get preg. ♠ Class III, IV: -> Advised not to get preg. -> If occur : ›TOP is discussed with family. -> If ptn. Insist to continue : › Prolong Hospitalization › C.S better to be avoided .

16. ☺ Pregnancy: ♠ ANC : frequent visits ( double ) ♠ Bed rest ♠ Diet: salt restriction ♠ Drugs: Long acting penicillin Prophylactic digitalis

17. ☺ Pregnancy: ♠ Monitoring -> Mother : ›Anemia › Infection › HF › Preg. HTN -> Fetus : › 1st: US › 2nd: US + Echo › 3rd: fetal wellbeing tests

18. ☺ Pregnancy: ♠ Hospitlization : › 28 – 32 wks › 36 wks -> delivery › Complications

19. ☺ Labour: ♠ Timing : -> acc. To method -> after fetus maturation ♠ Method : -> Vaginal delivery is the rule -> C.S better to be avoided ♠ Precautions : ☼ 1st stage : position , drugs , avoid bearing down . ☼ 2nd stage : shortening ☼ 3rdstage : Diuretics , Oxytocin ( with caution ) , No Ergometrine

20. ☺ Post partum care: ♠ Baby -> examination for cardiac anomalies ♠ Mother -> Bed rest ( 2 wks ) & antibiotics

21. ☺ Contraception : ♠ Tubal ligation ♠ Spermicidals & Mechanical ♠ IUD -> infection ♠ P.O.Ps ♠ COCs -> C.I

22. Thank you ☺

23. Contributors:BalighHamdyAymanGamalBaraaHelal HassanBaha’aElden MohammedBasemAbd El wahabTharwat Abu algamalEhabAslan