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
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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#
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@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
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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#
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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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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<
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.# Ehen does )lood volume increase to $%'(%& in pregnancyH
*# Ehat classi/cation o heart disease causese?treme atigue0 palpitations and dyspneaduring ordinary physical activityH
$# 5ow much pressure in the lungs causes
pulmonary edemaH1# (0I J signs and symptoms o @45F
# when is heparin given in @45FH
+# Ehy is heparin givenHL# Ehen is wararin givenH
.%# Ehat causes ,ugular vein distention in
R45F
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..# 5epatomegaly causes what symptomH
.*# ost common congenital anomalycausing R45F
.$'.1care given in last trimester to ensureetal growth
.(# 4igns and symptoms o R45F
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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#
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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
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*%'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-
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A CLIENT WITH ARTIFICIAL VALVEPROSTHESIS
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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
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A CLIENT WITH VENOUSTHROMBOEMBOLIC DISEASE
-$ncreased risk due to blood stasis inlower e%tremities from uterine pressureand hypercoagulability due to estrogen-Stasis& vessel damage& hypercoagulationleads to thrombus formation
'eep (ein )hrombosis "'()# leads topulmonary emboli for women above *+
y,o; pain or redness in the calf of a leg---avoid use of constrictive knee. highstockings& sitting with legs crossed atthe knee& or standing too long
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'iagnosis/-'oppler 0,S
Management/•bed rest& heat& elevation•$( 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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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
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P%l&ona'( !&olis&/ chief danger ofthrombophlebitis "medical emergency#
Chest painSudden dyspneaCough with hemoptysis)achycardia or missed beats
Severe di88iness or fainting fromhypotension
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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
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Ass!ss&!nt$
+,- &./011 &l/ hemoglobin level of awoman with SC'9Weekly 5S)
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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#
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@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
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: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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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
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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
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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$B%: detects hemophilia in a male fetus
contraindicated if fetus has a coagulationdisorder
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-2ere are four possible ou/comesfor /2e baby of a 1oman 12o is acarrier. -2ese four possibili/iesare repea/ed for eac2 and everypregnancy:
). A girl 12o is no/ a carrier4. A girl 12o is a carrier*. A boy 1i/2ou/ 2emop2ilia5. A boy 1i/2 2emop2ilia
0i/2 eac2 pregnancy, a 1oman12o is a carrier 2as a 4(6 c2anceof 2aving a son 1i/2 2emop2ilia.
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!ince /2e fa/2er7s 8 c2romosomede/ermines /2e baby 1ill be a girl,
all /2e daug2/ers of a man 1i/22emop2ilia 1ill be carriers. Noneof 2is sons, 12ic2 is de/erminedby /2e fa/2er /2roug2 2is '
c2romosome, 1ill 2ave2emop2ilia.
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Idiopathi) Th'o&o)(top!ni) P%'p%'a$
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'!
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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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