Book of Medical Disorders in Pregnancy - Tintash

ability to carryon household task.
Hemoptysis may be the only warning
sign in some cases.
During labour - Hospitalization at least
two weeks prior to term especially in
Class II cardiac cases should be
mandatory. Prophylactic antibiotics
should be given during labor and
puerperium. Labour should be conducted
in a semi-recumbent position. An increase
in pulse rate to 115 per minute
and a respiratory rate of 28 per minute
associated with dyspnea indicate impending
congestive cardiac failure.
If the cervix is not fully dilated any
attempt to deliver the baby will
precipitate congestive heart failure,
therefore, the patient should be sedated
with morphine, and properly digitalized.
If the cervix is fully dilated and decompensation
of heart occurs then immediate
delivery by forceps is indicated
to avoid bearing down. The patient
should be sitting up if possible and caudal
anesthesia administered, which is
safer.
Sudden collapse of cardiac pati-ents
after delivery can occur due to engorgement
of splanchnic vessels, Treatment
is sedation, digitalization, extremity
tourniquet and abdominal binder.
In normal patients a rise of about 30 per
cent in cardiac output occurs after labor
and continues for about four days.
Rarely there is congestive heart failure
within the first 24 hours or after 4 to 5
days postpartum. Bed rest for 2 weeks
during postpartum period and contraception
advise which should be given
to these patients.
Class III and IV:
80
These patients constitute nearly 12 per
cent of the total pregnancies complicated
with cardiac disease. They can go into
congestive cardiac failure easily, and
anytime through the pregnancy. For
Class IV patient’s delivery by vaginal or
surgical method carries the risk of
maternal mortality in nearly 50 per cent
of the cases. The physician should
recommend against pregnancy in both
Class III and IV type of cardiac patients.
However if he finds the patient in
advanced stage of pregnancy he should
hospitalize her and plan for vaginal
delivery. The heart disease alone is
never an indication for caesarean section.
Surgery in pregnancy complicated
with rheumatic heart disease carries 30
per cent maternal mortality. These patients
tolerate surgery and anesthesia
rather poorly especially spinal anesthesia.
Cardiac patients are known to
have a super normal hypotensive response
to sympathetic paralysis.
Indications for caesarean section are
obstetrical complications, coarctation of
the. aorta, aneurysm, and sub arachnoid
hemorrhage.
Vaginal delivery - This should be
favored over caesarean section for most
patients. The majority of patients can be
handled with regional anesthesia
(Pudendal or epidural block). Hypotension
should be avoided. When vag-inal
delivery is planned, the patient should be
in hospital, with all precautions taken to
protect her from respiratory infection.
She should be provided with complete
bed rest, liberal use of oxygen and
digitalized. The use of ergometrine is not
recommended during management of
third stage of labour. These agents