Maternal Health Module 7

How does systolic varies during pregnancy?

12 weeks - same pre pregancny 13+ decreases as weeks progress

How much does plasma volume increases by 30 weeks? RBC?

1200-1500 ml, 250-450 ml

How does the diastolic bp varies during pregnancy?

1st trimester diastolic decreases 20-32 weeks drops 33+ increases gradually

note

25-30 week peaks and decline 40 weeks. increase stroke volume/heart rate/ oxygen demand

When does wbc increase during pregnancy?

2nd trimester

When does circulation and coaglation times decreases?

32 weeks and normal by term

What age group is most likely to experience myocardial infarction?

33+

When does the heart return to its regular position after birth?

6 months

note

anitcoagulation therapy should be discontinued during pregnancy and resumed post partum.

What is the primary medical management for a pregnant mother experiencing a valve replacement mechanically?

anticoagulation

What is an abnormal opening between the atria? L/R Shunt, most common, asymptomatic, lead to cgf/arrhythrmia, increase plasma volume, emboli

atrial septal defect

When should coarctation of the aorta be treated?

before pregnancy

What is given to release chest pain and reduce risk of arrhythmia in mitral valve prolapse ?

beta blockers

note

beta blockers treat mitral valve prolapse

What are the 2 major things blood pressure is influenced by during pregnancy?

cardaic output, systemic vascular resistance (bp though is same or decreased)

What are the physiological adaptation for the cardiovacular system during pregnancy?

cardiac hypertrophy, upward diaphragm displacement, elevated heart, apical impulse shifted (heart new location is elevated upward and rotated forward)

note

cardiac output is reduced when pregnant women is turned left latereal position to supine positino

What do women with prexisting cardiac disease need during pregnanncy?

close monitoring

What is a localized narrowing of the aorta, near the inssertion of the ductus? These have htn in higher extremeties and hypotension in lower extremeities

coarctation of the aorta

note

components of tetralogy of fallot are VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta leads to a right to left shunt.

What are the procedure for mi?

coronary angioplasty, stenting

What are treatments for mitral stenosis? and interventions

daily penicillin, diuretics, bb; reduce activity, restrict na, monitor weight, pain control (epidural preferred to prevent tachycardia)

note

decrease in factors that inhibit coaguation, decreased fibrinolytic activity, increase in clotting factors are things that occur to the ciculation and coagulation time in women during pregnancy

What can arise from compression of the iliac veins and inferior vena cava?

dependent edema, varicose veins, hemorrhoids, venous bp

How often should the brachial pulse be measured during pregnancy?

each visit

What is the major cause of cardiac decompensation?

fever

note

for mitral stenosis side lying position is preferred for delivery

What is the risk for anticoagulation therapy in valve replacement pregnant mothers?

hemmorhage

What are the levels of anemia?

hemoglobin < 11, hematocrit < 33 for 1st and 3rd trimester; <10 and <32 2nd trimster

What are the complications of coarctation of the aorta?

htn, hf, aortic dissection, rupture of associated cranial berry aneurysm, hemorrhage, ischemic heart disease, infective endocarditis

What blood state is pregnancy considered?

hypercoagulable (increased risk for thromboembolic disease)

What are the major cardiovascular changes during pregnancy?

increasaed intravascular volume, decreased systemic vascular resistence

What are the signs and symptoms cardiac disease pregnant mothers should report to the HP?

ireguar, rapid, weak pulse, edema, crackles at base, orthopnea, increase dyspnea, tachynpea, moist freuent cough, cyanosis of nail bed

note

management is focused on minimizing stress on the heart as CO increases.

What are the increased risks for decompensation?

maternal arrhythmia, heart failure, preterm birth, fetal growth restriction, maternal/fetal death

What are the cardiovascular adaptation during pregnancy?

meet metabolic demands, provide fetal development/growth, protection

What is narrowing of the mitral valve due to stiffening of the valve leaflet. obstruct blood flow from atrium to ventricle. This causes dyspnea on exertion and eventually rest.

mitral stenosis

What is a common benign condition where there's a midsystolic click and late systolic murmur? most are asymptomatic allow back flow of blood. symptoms consist of atypical chest pain at right on the left side, syncope. No response to nitrates, anxiety, dyspnea on exertion, palpitation

mitral valve prolapse

What is the medical management of myocardial infarction for pregnant mothers?

morphine, nitrates, lidocaine, bb, mg sulfate, ca antagonist

What disease can be

myocardial disease develops, valvular disease, congenital heart defect then cardiac decompensation can occur

What is an acute ischemic event that frequently happen in the last trimester of pregnancy? Or during labor and birth

myocardial infarction

note

normal decrease in hemoglobin and hematocrti due to increase in blood volume causing physiologic anemia of pregnancy and common during 2nd trimester.

What are the things the cardaic increases during pregnancy?

output, stroke volume, hr, oxygen demand

What is crucial for consideration with pregnant mothers having a myocardial infarction?

pain control

What congential cardiac disease has a high risk for endocarditis, pulmonary emboli, chf, pulmonary htn, not common in pregnancy

patent ductus arteriosus

What allows for normal BP despite the increase in cardiac system?

peripheral vasodilation

note

pregnacny decreases systolic vascular resistance

note

pregnancy can lead to pac, pvc, dysrhthymia

note

pregnancy for mitral valve prolapse may alter or allevite murmur, click, and symptoms

note

pregnancy speeds up the deterioration of bioprosthetic heart valve.

note

pregnant mother with valve replacement do not require to continue taking anticoagulation and to resume postpartum

note

pregnants changes position may have a fall of 30 mm systolic

What can mitral stenosis cause?

pulmonary edema, atrial fibrilation, right side heart failure, infective endocarditis, pulmonary embolism, hemoptysis

What disease have the highest risk for mortality in pregnany?

pulmonary htn, complicated coartation of aorta, marfan syndrome (aortic involvement)

What are interventions for

report thromboembolism

What is the treatment for coarctation of the aorta?

rest, antihypertensive meds, vag birth preferred, epidural, shortening 2nd stage of delivery, BB continued, prophylactic antibiotics (for endocarditis)

What causes mitral stenosis?

rheumatic heart disease

What are the symptoms if tetralogy of fallot is not repaired?

right to left shunting, reduced blood flow, increasing hypoxemia

What is the goal during pregnancy for someone with mitral stenosis?

shorten 2nd stage of labor and side lying delivery

note

shunt is fluid moving from an area of greater pressure to lesser

What should be reviewed at each prenatal and perinatal visit for cardiac issued pregnancies?

signs/symtoms of cardiac decompensation (increasing fatigue, difficulty breathing, smothering, cough, palpitation, rise heart beat)

When is the brachial pulse during pregnancy the lowest and highest?

sitting position, lateral recumbent position (intermediate when decline)

What audible changes occur to the heart during pregnancy?

splitting during s1 and s2, third heart sound r/t diastolic filling (systolic ejection murmurs)

What syndrome may arise if a pregnant is supine?

supine hyotensive syndrome

What are the recommendations for tetralogy of fallot?

support hose, blood volume maintenance, prophylactic antibiotics

What is the treatment for prosthetic heart valve thrombosis?

surgery

note

surgical repair should be done prior to conception for tetralogy of fallot. If not more blood to right to left shunting and causing a reduced blood flow increasing hypoxemia.

What is the most common cyanotic heart disee during pregnancy?

tetralogy of fallot

What is an abnormla openieng of the right and left ventrical? L/R shunt, diagnosed early in life, small and uncomplicated, large version can cause chf, pulmonary htn

ventricular septal defect

What drug is used for anticoagulation in valve replacement pregnancies?

warfarin (safe for breast feeding)

What is the frequency of appointments for care management of cardiac disease during pregnancy?

weekly

note

women with bioprosthetic heart valve do not require anticoagulation therapy

note

RBC during pregnancy dependent on IRON levels

What needs to be repaired in a tetralogy of fallot in order for pregnancy to have a risk?

VSD, pulmonary stenosis

note

Birth within 2 weeks of MI increases risk of death