Book of Medical Disorders in Pregnancy - Tintash

Mitral valves prolapse: Cardiological
and echocardiographic evaluation
prenatally for mitral regurgitation,
Surveillance and treatment of
arrhythmias in pregnancy. ? Antibiotic
prophylaxis for delivery if regurgitation.
Atrial septal defect:
Pre pregnancy: screen for arrhythmias
and/or pulmonary hypertension (PH);
manage accordingly both before and
during pregnancy (if undertaken)
Prenatal routine except if arrhythmias
and/or PH Labor Delivery: Screen for
arrhythmias, monitor BP, ovoid fluid
overload Postnatal: encourage early
mobilization
Patent ductus arteriosus:
Pre pregnancy: screen for PH and
manage accordingly before and during
pregnancy (if undertaken), Prenatal:
screen for PH, Labor/delivery/postnatal:
monitor BR attention to normal fluid
balance, antibiotic prophylaxis except
for normal deliveries.
Coarctation of the aorta:
Pre pregnancy: screen for aneurysms
and/or aortic valve disease and manage
appropriately prior to conception.
Prenatal? Consider termination with
severe uncorrected disease
Labor/delivery/postnatal: avoid
hypertension, antibiotic prophylaxis
except for normal delivery, screen
newborn for congenital heart disease
(CHD).
Ventricular septa! defect:
Pre pregnancy: screen for PH and
manage accordingly, Consider repair of
84
uncorrected lesions, counseling about
CHD risks, Prenatal: serial
echocardiography and manage
accordingly, Labor/delivery: avoid
hypertension, antibiotic prophylaxis
except for normal delivery Postnatal:
careful fluid balance, early ambulation
Primary pulmonary hypertension:
Pre pregnancy: counsel against pregnancy;
sterilization requested Prenatal:
consider termination, obstetric and
cardiological joint care, early
anesthesiologist consultation, Thromboembolism
prophylaxis, consider
hospital admission, and monitor Sa02,
fetal surveillance labor/delivery: high
dependency setting (degree of invasive
monitoring varies); dilemma over
induction (end pregnancy) versus
spontaneous (shorter labor) onset of
labor, oxytocic or E series
prostaglandins safe, 02 at 5-6 l/min,
monitor Sa02 continuously, monitor BR
maintain fluid balance. Epidural
analgesic. Preferable (? reduce/stop
anticoagulation for a few hours for
delivery).
Postnatal: Maintain high dependency
monitoring, 02 therapy and throm-Bo
embolism prophylaxis, vigilance for
fluid retention and consequences,
consider sterilization
Eisenmenger's complex:
As for primary pulmonary hypertension
Echocardiography may be helpful.
Tetralogy of Fallot: Pre pregnancy:
surgical correction, evaluation of cardiac
status after, corrective surgery, Prenatal:
consider termination with uncorrected
lesions, monitor maternal Sao2 and
exercise tolerance, and consider rest and