Book of Medical Disorders in Pregnancy - Tintash

may require vigorous resuscitation and
administration of atropine and isoproterenol
for treatment of such bradycardia.
Babies born to mothers who have
been on propranolol may be small for
gestation age and may have a small
placenta.
The student may be interested to note
that small doses such as 10 mg of
propranolol four times a day have been
associated with significant neonatal
bradycardia, hypoglycemia, and respiratory
distress. These findings suggest
a cumulative effect of the drug on the
fetus. Therefore it is advised to avoid
using this drug during pregnancy.
Congestive heart failure - Moist rales
are usually audible at the bases of the
lungs. The lungs may also become
atelectatic due to the elevated diaphragm,
which is pushed upward by the
gravid uterus. Peripheral edema may
result due to compression of the inferior
vena cava by the gravid uterus. The heart
size may be difficult to assess clinically
because of the lateral displacement of
the apex by the elevated diaphragm.
Management - Once it has been
established that the patient is in congestive
cardiac failure, and then management
should include digitalization,
salt restriction, and judicious use of
diuretics. The use of diuretics in pregnancy
is not recommended unless they
are absolutely necessary. Diuretics can
cross the placental barrier and cause fetal
electrolyte and water depletion. In the
case of thiazide diuretics, neonatal
jaundice and severe thrombocytopenia
may result.
Prevention of Endocarditis: Patients
with heart disease are at a greater risk of
78
contracting subacute bacterial
endocarditis from bacteremia, which can
even occur during delivery; therefore it
is important to give these patients
prophylactic antibiotics.
An uncomplicated vaginal delivery may
not be associated with bacteremia.
Current regimen advocated is aqueous
penicillin G 2,000,000 units intramuscularly
or intravenously, or ampicillin,
1.0 gm intramuscularly or intravenously
plus gentamycin 1.5 mg/kg
(not to exceed 80 mg) intramuscularly or
streptomycin 1.0 gm intramuscularly.
The initial dose should be given 30
minutes to 1 hour prior to delivery. If
gentamycin is used, a similar dose of
Genta- mycin and penicillin or ampicillin
should be given every 8 hours
for two additional doses. If streptomycin
is used, then a similar dose of streptomycin
and penicillin or ampicillin
should be given every 12 hours for two
additional doses.
Thromboembolic complications:
Patients with heart valve replacement are
often advised to take anticoagulants
throughout their life. When they conceive,
only two out of three pregnancies
have a chance of normal outcome. These
patients should be informed of the risk
and advised against pregnancy.
Coumarin anticoagulants:
These agents cross the placental barrier,
and have been reported to be associated
with fetal abnormalities. The
abnormalities which develop are referred
to as warfarin embryopathy. They
include a hypoplastic saddle type nose
and bone abnormalities, the most