Book of Medical Disorders in Pregnancy - Tintash

with abnormal echo-cardiogram, medical
therapy if symptomatic, anticoagulation.
Labor/delivery:
Monitor for heart failure, avoid fluid
overload, care with invasive monitoring.
Postnatal: avoid fluid overload, discuss
contraception.
Cardiac arrhythmias:
Pre pregnancy: investigate and rest.
Prenatal, labor, delivery or postnatal:
maintenance of therapy to control
arrhythmia, cardio conversion can be
used
Myocardial infarction:
Pre-pregnancy: assess cardiac function
(especially echocardiography and stress
test), counsel for pregnancy on basis of
results, low dose aspirin.
Prenatal: avoid strenuous activity,
surveillance for failure and arrhythmias,
management as for non-pregnant,
surgery can be carried out in pregnancy,
thrombolytic therapy has been used.
Labor/delivery: monitor ECG, supplementary
oxygen, epidural beneficial.
Postnatal: avoid fluid overload and
exertion, discuss contraception (avoid
combination oral preparations)
Idiopathic hypertrophic subaortic
stenosis
Pre-pregnancy: genetic counseling if
parents have condition
Prenatal: limit activity: beta blockers for
symptomatic parents.
86
Labor/delivery/postnatal: Avoid dehydration
hypotension, beta-blockers for
tachycardia, endocarditis prophylaxis for
complicated deliveries.
REFERENCES:
1. Risk and predictors for pregnancyrelated
complications in women with
heart disease. Circulation. 96: 1997;
2789-2794.
2. Prospective multicenter study of
pregnancy outcomes in women with
heart disease. Circulation. 104: 2001;
515-521.
3. Maternal and fetal outcomes of
subsequent pregnancies in women with
peripartum cardiomyopathy. N Engl J
Med. 344: 2001; 1567-1571.
4. Gestational diabetes and the incidence
of type 2 diabetes: A systematic review.
Diabetes Care. 25: 2002; 1862-1868.
5. Cardiac risk in pregnant women with
rheumatic mitral stenosis. Am J Cardiol.
91: 2003; 1382-1385.
6. Early and intermediate-term outcomes
of pregnancy with congenital aortic
stenosis. Am J Cardiol. 91: 2003; 1386-
1389.
7. Obesity, obstetric complications and
cesarean delivery rate—a populationbased
screening study. Am J Obstet
Gynecol. 190: 2004; 1091-1097.
8. Use of antithrombotic agents during
pregnancy. Chest. 126: 2004; 627S-
644S.
9. Cardiovascular health after maternal
placental syndromes (CHAMPS): A
population-based retrospective cohort
study. Lancet. 366: 2005; 1797-1803.
10. Pregnancy-associated cardiomyopathy:
Clinical characteristics and a
comparison between early and late
presentation. Circulation. 111: 2005;
2050-2055.