Pregnancy with heart disease

Overview pregnancy with heart disease, rheumatic heart disease in the most common, accounting for about 80%. especially in mitral stenosis the most common, but in recent years the incidence rate has been gradually declining, with the first incidence of heart disease increased. During pregnancy, pregnant women undergoing a series of changes in the body and increase the burden on the cardiovascular system. Under normal circumstances, through decompensated heart can bear, but because the heart of pregnant women suffering from heart disease and has receded, This is an additional burden on cardiac function may cause a further decline, causing heart failure, the threat of mother-to-child lives, we must pay attention to. 1, pregnancy and childbirth to heart the impact of pregnancy when blood volume increased by about 30 ~ 40%, rapid heart rate, per minute cardiac output increased to 32 ~ pregnancy up to 43 weeks peak, when the heart is the most important burden. Gradually reduce, postpartum 4 ~ 6 weeks to recover. In addition, water, sodium retention, the increase in oxygen consumption, uterine vascular areas with the increase in output, placental circulation due to the formation of increased diaphragmatic position to make changes in the heart, have the heart to make the burden of pregnancy with the increase gradually worsened. Cardiac birth increased burden on the more obvious, the first stage of each uterine contractions, increase blood circulation around the resistance and upon reflection output, labor, each uterine contractions about 300-500ml of blood from the Palace wall entering the center circle, cardiac output increased by about 20%. Mean arterial pressure increased about 10%, resulting in left ventricular load further accentuated. In addition to the second stage of labor, also muscular and skeletal muscle contraction, the more peripheral vascular resistance increase, coupled with labor force spurt gas, pulmonary pressure increased significantly, while increasing abdominal pressure, heart visceral blood flooded, the heart of the burden at this time the most important. The third stage of labor uterus after delivery reduced sinusoids closed placental circulation stop. Sinusoids in the presence of uterine blood suddenly entered the blood circulation, making painstaking efforts to rapidly flocking to the heart, it can lead to heart failure; the other hand, due to intra-abdominal pressure drop, blood stagnation is in splanchnic vascular bed, and a serious effort to reduce, causing peripheral circulatory failure. Postpartum 1 ~ 2 days, the organization retention of moisture to enter the blood circulation, resulting in systemic blood volume has again increased the short-term, Heart load has increased yet again. Because of the above reasons, in the heart of pregnant women at 32 weeks of pregnancy, childbirth and postnatal three days cardiac load weight, prone to failure. Therefore, the right heart with pregnancy, the treatment should be more attention. Second, the fetal heart of the fetal heart, and the severity of the disease and cardiac decompensation functional state, and so on. Mild compensatory function well, little effect on the fetus; In case of heart failure, can hypoxia and uterine congestion caused miscarriages, premature or stillbirth. Diagnosis is often difficult diagnosis, patients always have great history flustered shortness of breath, increased after pregnancy. During the district to be heard before the diastolic murmur or two above systolic murmur, will be a serious legal or Benma such as atrial fibrillation. Heart of pregnancy and childbirth and the impact of compensatory function of the heart, compensatory function in the day-to-day based on the physical activity of tolerance capability as a standard, is divided into four : first-class general physical activities without cardiac dysfunction performance; the second level of physical activity in general slightly restricted, rest when normal, day-to-day physical activity after fatigue weakness, shortness of breath and other flustered performance; 3rd grade general physical activity significantly limited, less than the day-to-day operation of physical activity that is noticeable symptoms. Had previous history of heart failure, it is this level; 4th grade when resting cardiac dysfunction still performance; decompensated heart function in three or more, and often sudden severe heart failure, so early diagnosis and treatment is extremely important. Early performance of heart failure : minor activities that have alarmed, chest tightness, shortness of breath, pulse 110 times / hours more, 24th in respiratory / pulmonary and above the bottom of a small number continued to be heard Rale wet; demonstrated more severe punishment : cough, hemoptysis and pink bubble-like sputum (whose failure can be found within cells), the labial surface of cyanosis, the jugular vein engorgement, significantly lower extremity edema, stationary supine resting pulse and respiration is still faster, lung bottom of a continued wet sound hepatosplenomegaly, tenderness; At the worst performance : respiratory center, I Zhou facial cyanosis more important, such as tachycardia or atrial fibrillation. X-ray can show the sector expanding. Suggest ECG arrhythmia or cardiac defect. Treatment (a) do a good job in family planning publicity and the work of women suffering from heart disease, should be aware of contraception, And then the children are OK mobilization sterilization. Where the following circumstances, should seek termination of pregnancy : 1. Heart is heavy, compensatory function in 3 above; 2. Previous pregnancy or a history of congestive heart failure that occurred in early pregnancy failure; 3. Rheumatic heart diseases, severe mitral valve disease associated with pulmonary hypertension or cyanotic congenital heart disease; 4. Sexual activities with rheumatic fever, subacute bacterial endocarditis and serious arrhythmias; 5. Serious congenital heart disease and myocarditis. (2) the method of pregnancy termination of pregnancy in March within feasible abortion, "12 Week" 15 weeks. If necessary, carefully consider the use of forceps for termination of pregnancy. Second-trimester labor induction, in particular the surgery is more dangerous and should be avoided if possible. If the conditions can be observed in the active treatment, so that pregnancy continue. Where there congestive heart failure, heart failure in control, after termination of pregnancy. (3) pregnancy on the following two cardiac patients should strengthen prenatal examinations, at least every two weeks a meeting. Patients should have adequate rest and avoid heavy manual work, into low-salt diet and the prevention of respiratory tract infection, anemia should be treated more aggressively, before the expected date of admission to two weeks off. Heart failure should be immediately hospitalized. Pregnant women on digoxin-like drug tolerance poor, medication pm (particularly in the fast time of digoxin) should pay attention to toxicity, If vomiting, chest pain and slow pulse, and so on. Taking the best role during pregnancy and more rapid excretion of digitalis drugs such as digoxin 0.25 mg oral 2 / day, 2 ~ 3 days after service, as appropriate, a change that does not require saturated volume unlikely event of failure, have room for increasing dose. Maintained for a long time with the volume very difficult to gauge, from the pre-production phase far, his condition improved after withdrawal. After the labor needs can rapidly as of digoxin. (4) dealing with labor in recent years that the cesarean section when hemodynamic changes than vaginal delivery small, poor cardiac function, may consider epidural anesthesia for cesarean section, cardiac intensive care, postoperative cardiac situation improves. 1. Do a good job in the first stage of maternal thinking, emotional stability. Patients preferred a semi-sitting position, every half-hour measurement of blood pressure, pulse, respiration once. The proper use of tranquilizers, such as ampules, phenergan, so that access to mental comfort, allaying fears the tense mood. If the pulse per minute over 120 times and over 28 times to breathe / stakeholders, have expressed an indication of heart failure, active, If given oxygen and a quick shot of medicine, ammonia injection discretion theophylline, drugs, Mao Xuan strophanthinik on or West to Portland, when necessary to morphine, usage is as follows : ① ammonia theophylline 250 mg in 25% glucose within 20 ml injection slow, 4 ~ 6 hours after the repeat. ② drug Mao Xuan strophanthinik on K0.125 0.25 ~ 25% increase in glucose within 20ml slow intravenous (about 1 End Note 0 minutes). Injection to observe the heartbeat and pulse, such as cardiac arrhythmia, the slow pulse, and we should stop using them immediately. Need four hours later to 0.125 mg. ③ West to Portland 0 .2-0.4 mg in 20 ml of 25% glucose intravenously within slow. If necessary, after 4 hours to 0.2 mg. Attention to the matters with the drug Mao Xuan strophanthinik on. ④ pulmonary edema, may give 50% alcohol oxygen inhalation, every 20 ~ 30 minutes, remove lung and tracheal bubble. Oxygen can be used interchangeably. Furosemide 40mg to 20 ~ 25% for intravenous glucose 20ml. Diuretics more than 15 minutes after the injection Onset, a ~ 2 hours after the peak. 2. The second stage of labor Palace open its mouth after all, used vacuum extractor or forceps for midwifery, as soon as the end of maternity leave, in order to avoid excessive maternal strength. Breech births OK butt when necessary traction. 3. The third stage of the prevention and control of post-partum hemorrhage. After delivery, the immediate placement of an abdominal - 2kg heavier sandbags (or hand massage), prevent abdominal pressure due to decreased blood into surrounding splanchnic vascular and circulatory failure. Subcutaneous injection of 10 mg of morphine, or 50 ~ 100 mg ampules, quiet rest. For the prevention of postpartum hemorrhage, when necessary, may intramuscular injection of oxytocin 10-20u. Ergometrine increased venous pressure, as far as possible should not use. (5) postpartum treatment for postpartum not immediately Mobile maternal and closely watched, two hours later in stable condition and may be returned to the ward. 3 days postpartum, especially the former 24-hour observation period must be strengthened to guard against heart failure occurred, and make all emergency preparations. Postpartum should rest in bed for two weeks with congestive heart failure, as appropriate, should be extended. Generally it is advisable to not breastfeeding, without heart failure, the discretion breastfeeding. Postpartum infection and easy with subacute bacterial endocarditis, preventive antibiotics. Less severe diseases, and we should pay attention to contraception; Reproductive right is not appropriate, should be advised OK sterilization surgery. Postpartum surgery in about a week, at this time of the heart has stabilized, the restoration of basic physical, post-natal infection has been ruled out. Have heart failure, the first control and then select the time sterilization.