cardiovascular disorders of pregnancy

8/19/2019 Cardiovascular Disorders of Pregnancy

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CardiovascularDisorders of

Pregnancyby: Ampe C. Asuncion, RN, MAN

CARDIOA!C"#ARDI!ORD$R! O%

PR$&NANC' P. ()*

+y:

Ampe C. Asuncion,RN, MAN


2/42

CVDs that most commonly cause difcultyduring pregnancy:

Valve damage due to RF or Kawasaki disease

Congenital anomalies like atrial septal deector uncorrected coarctation o the aorta

Aortic dilatation due to aran!s syndrome

"ncreased circulatory volume: the danger opregnancy in a woman with cardiac disease#

$%&' (%& increase in )lood volume andcardiac output at weeks *+'$* ,ust ater the)lood volume peaks

-renatal check'up should )e done as early as

. week ater the /rst missed period#


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FAC23R4 25A2 CA2673R"86A -R679A9C A4 5"75R"4K

;-#(.(


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Disease

"' uncompromised= ordinary physical activitycauses no discomort= no s>s o cardiacinsufciency> no anginal pain

""' slightly compromised0 e?cessive atigue0

palpitation0 dyspnea or angina during ordinaryphysical activity#

"""' markedly compromised= less than ordinaryactivity causes e?cessive atigue0 palpitations0dyspnea or angina#

"V' severely compromised= ina)ility to carry outactivities0 symptoms elt even at rest#


5/42

@et' 4ided 5eart Failure

Causes:mitral stenosis and insufciency and aorticcoarctation#

-athophysiology: Deective mitral valve causes )ack

pressure on pulmonary circulation0decreased systemic )lood pressure andpulmonary hypertension occurs#

*( mm 5g pulmonary pressure causesuid to leak into alveoli and cause

pulmonary edema


6/42

4igns and 4ymptoms:

Blood' tinged sputum due to rupture ocapillaries leaking )lood into alveoli

Fatigue0 weakness0 diiness rom lack oo?ygen

3rthopnea due to severe pulmonary edema

-aro?ysmal nocturnal dyspnea

anagement:

Anticoagulants or mitral stenosisD#3#C#' 5eparin in early and last month o

pregnancy0 no teratogenic eects and doesnot cross the placenta;no coag# pro)lems at)irth<


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Eararin may used ater week .*#

Antihypertensives

Diuretics to reduce )lood volume

Beta)lockers to improve ventricular /lling#

4erial 28 ater weeks $%'$* and non'stresstest to monitor etal growth

Balloon valve angioplasty to loosen mitralvalve adhesions

Complications:-oor placental perusion= -2@= maternal death

"ntrauterine growth restriction

4pontaneous miscarriage= Fetal death


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Right' 4ided 5eart Failure

Causes: 'pulmonary valve stenosis

'atrial G ventricular septal deects

-athophysiology:

Deective ventricle causes )ack'pressure

and systemic venous circulation iscongested causing ,ugular vein distentionand portal hypertension= liver and spleen

)ecome distended#


10/42

4igns and 4ymptoms:

5epatomegaly presses on diaphragm causing H

Ascites due to distention o a)dominal vessels

-eripheral edema= splenomegaly

6isenmenger syndrome: ;2ardive Cyanosis< right'

to' let atrial or ventricular septal deect= mostcommon congenital anomaly causing R4 heartailure#

6ective contraception or uncorrected 64=

woman is advised not to get pregnant5ospitaliation in last trimester ;3?ygen and AB7

analysis to ensure etal growth


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12/42

P$RIPAR-A# CARDIOM'OPA-':

' (%& mortality rate= no previous h? o heartdisease

' common in Arican' American women with -"5

' myocardiac ailure causes dyspnea0 chest pain0edema0 cardiomegaly

DiureticsAnti'arrhythmias

Digitalis

Anticoagulants to decrease throm)oem)olismCorticosteroids

C": oral contraceptives ;avoid urther

pregnancies= may need heart transplant<


13/42

.# Ehen does )lood volume increase to $%'(%& in pregnancyH

*# Ehat classi/cation o heart disease causese?treme atigue0 palpitations and dyspneaduring ordinary physical activityH

$# 5ow much pressure in the lungs causes

pulmonary edemaH1# (0I J signs and symptoms o @45F

# when is heparin given in @45FH

+# Ehy is heparin givenHL# Ehen is wararin givenH

.%# Ehat causes ,ugular vein distention in

R45F


14/42

..# 5epatomegaly causes what symptomH

.*# ost common congenital anomalycausing R45F

.$'.1care given in last trimester to ensureetal growth

.(# 4igns and symptoms o R45F


15/42

Assessmen/ of a 0oman 1i/2 CardiacDisease

Check pre'pregnancy status or signs o cardiac

disease= a simple cough may )e a sign opulmonary edema#

***Edema of PIH usually begins after week 20.

' 6dema o heart ailure can start anytime=irregular pulse0 rapid or difcult respirations0chest pain on e?ertion

Assess RR in sitting>lying position on /rst visitthen take RR in the same position or accuracy

Assess or capillary re/ll ;M( secs#


16/42

9ursing Diagnosis: De/cient knowledge regardingsteps to reduce the eects o maternalcardiovascular disease on the pregnancy and etus

9ursing "nterventions during pregnancy0 la)or anddelivery0 and postpartum:

onitor etal heart rate and maternal V>4 andcontractions reOuently

P.%% )pm Q let lateral position or 4F i withpulmonary edema

Avoid anemia )y taking iron supplements= low 9adiet

Fatigue' symptom o heart decompensation

4wan' 7an catheter' monitor heart unction

6pidural' low orceps or vacuum e?tractor can )e

used or )irth= no pushing allowed


17/42

*%'1%& increase o )lood volume within (minutes ater placenta is released

Anticoagulants0 digo?in0 anti)iotics

to prevent su)' acute endocarditis0stool soteners#

Assure mother that acrocyanosis is

normal or the )a)y3?ytocin is used with caution due

to increased B-


18/42

A CLIENT WITH ARTIFICIAL VALVEPROSTHESIS

-

Client is on anticoagulant therapy toprevent clotting

-Warfarin can cause congenital anomalies

in infants

-Heparin does not cross placenta

-Subclinical bleeding from anticoagulantcan cause dislodgement of placenta;observe for signs of petechiae andpremature separation of placenta


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A CLIENT WITH CHRONICHYPERTENSIVE VASCULAR DISEASE-associated with atherosclerosis or renaldisease

-Mother and child are at risk due to poor

placental perfusion-Betablockers and AC inhibitors toreduce B! by peripheral dilatation

-Methyldopa "Aldomet# is usuallyprescribed


22/42

A CLIENT WITH VENOUSTHROMBOEMBOLIC DISEASE

-$ncreased risk due to blood stasis inlower e%tremities from uterine pressureand hypercoagulability due to estrogen-Stasis& vessel damage& hypercoagulationleads to thrombus formation

'eep (ein )hrombosis "'()# leads topulmonary emboli for women above *+

y,o; pain or redness in the calf of a leg---avoid use of constrictive knee. highstockings& sitting with legs crossed atthe knee& or standing too long


23/42

'iagnosis/-'oppler 0,S

Management/•bed rest& heat& elevation•$( Heparin for 12. 23 hours& then•

SC Heparin every 41.12 hours for theduration of pregnancy through rotationof sites in arms and thighs•!)) monitoring• 5o additional heparin once laborbegins; 56 routine episiotomies orepidural anesthesia until at least 2 hourshas passed after last dose


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25/42

a

Antiphospholipid antiodi!s "aPLA#$.women are more prone to thrombi

formation& spontaneous miscarriages&fetal death and !$H.clients are started on aspirin or SCHeparin during pregnancy and d,c !! to

reduce '() -Corticosteroids to reduce antibodyformation-Contraceptives not initiated after

pregnancy to avoid coagulation 7 thrombiformation


26/42

P%l&ona'( !&olis&/ chief danger ofthrombophlebitis "medical emergency#

Chest painSudden dyspneaCough with hemoptysis)achycardia or missed beats

Severe di88iness or fainting fromhypotension


27/42

Si)*l! C!ll An!&ia/

9ecessively inherited hemolytic anemiacaused by abnormal amino acid in the betachain of hemoglobin which replaces aminoacid valine "HbS results#; lysine "non.

sickling hemoglobin "HbC#Cold temperature, high altitudes causeviscosity due to dehydration4 in 4+ African. American has it

Can cause blockage in ma:or organs aswell as placental circulation causing BWand fetal death


28/42

Ass!ss&!nt$

+,- &./011 &l/ hemoglobin level of awoman with SC'9Weekly 5S)


29/42

Mana.!&!nt/

!eriodic e%change transfusions toreplace sickled cells and removeaccumulated bilirubinSi)*l! )!ll )'isis/ control pain& give

61& increase fluid volume to lowerviscosity "hypotonic. +?2< saline#56 iron,folic acid supplements duringpregnancySigns of infection that causes fever&increased perspiration; respiratory inf%n"admission to rule out sickle cell crisis#


30/42

@eep woman well. hydrated in laborpidural anesthesia if CS

arly ambulation and pressurestockings to prevent thromboembolism*.= months/ screening of infants whenfetal hemoglobin converts to an adult

pattern

PUBS/ A&nio)!nt!sis/ detects diseasein the few beta chains present in utero


31/42

:Thalassemia in Pregnancy

Autosomal recessive blood disordersthat cause poor hemoglobin formation and

severe anemia in children

Common in Med, African and Asian

populations

Treatment: folic acid and packed RBC to

combat anemia


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33/42

Treatment:

Chloro!uine: drug of choice%ulfado"ine) Pyrimethamine: .rd trimester

Contraindicated /rugs: !uinine, malarone,

tetracyclines should not be given duringpregnancy or lactation

000Antimalarials: reduce incidence of B1

and PT


34/42

2on 1illebrand /isease:

autosomal dominant trait in childhood

that causes menorrhagia and fre!uent

epista"is

&f undiagnosed+untreated, can cause

spontaneous miscarriage or PPhemorrhage

3ormal platelets but prolonged bleeding

time

Reduced factor 2&&& antigen andcoagulation activity

Transfusion of cryoprecipitate or fresh

fro4en plasma before labor


35/42

5emophilia B 6Christmas /isease7

se")linked male disorder

-emale carriers have such reduced level

of factor &8 6..97 that cause spontaneous

miscarriage or hemorrhage of labor

%creening before pregnancy

Blood transfusion of factor &8

concentrate or fresh) fro4en plasma

P$B%: detects hemophilia in a male fetus

contraindicated if fetus has a coagulationdisorder


36/42

-2ere are four possible ou/comesfor /2e baby of a 1oman 12o is acarrier. -2ese four possibili/iesare repea/ed for eac2 and everypregnancy:

). A girl 12o is no/ a carrier4. A girl 12o is a carrier*. A boy 1i/2ou/ 2emop2ilia5. A boy 1i/2 2emop2ilia

0i/2 eac2 pregnancy, a 1oman12o is a carrier 2as a 4(6 c2anceof 2aving a son 1i/2 2emop2ilia.


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!ince /2e fa/2er7s 8 c2romosomede/ermines /2e baby 1ill be a girl,

all /2e daug2/ers of a man 1i/22emop2ilia 1ill be carriers. Noneof 2is sons, 12ic2 is de/erminedby /2e fa/2er /2roug2 2is '

c2romosome, 1ill 2ave2emop2ilia.


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Idiopathi) Th'o&o)(top!ni) P%'p%'a$

5a%toi&&%n! illn!ss )a%sin. d!)'!as!dplat!l!ts6 )an o))%' an(ti&!7 t'i..!'!d( a o%t o8 9i'al in8!)tion5&in%t! p!t!)hia! o' la'.! h!&o''ha.!s

app!a' on :o&an;s od(6 8'!


41/42

Mana.!&!nt o8 ITP/

!latelet transfusion, plasmapheresis6ral prednisone

Co&pli)ations$

decreased platelets leads to increasedbleeding at birthAntiplatelet factor can cause placentaand cause platelet destruction in the

newborn5ewborn may acuire disease


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cardiovascular disorders of pregnancy

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