Chapter thirty-five | Medical Disorders During Pregnancy
Chapter thirty-five | Medical Disorders During Pregnancy
Two | CARDIAC | HEART DISEASE IN PREGNANCY
CARDIOVASCULAR CHANGES DURING PREGNANCY
CARDIOVASCULAR CHANGES DURING PREGNANCY
There are significant hemodynamic and cardiovascular changes during normal pregnancy. In summary, there is significant increase in cardiac output (thirty to fifty percent), heart rate, plasma volume (forty to forty-five percent) and red cell volume (fifteen to twenty percent) with slight reduction in blood pressure. While a normal heart can withstand these extensive hemodynamic changes, with cardiac disease, the patient may not be able to withstand these changes and there is risk of cardiac failure and death during the following five times
One. Between six to eight weeks of pregnancy remodeling
Two. Between thirty to thirty-four weeks of pregnancy
Three. Second stage of labour
Four. Immediately after delivery
Five. Second week of puerperium (cardiac failure and thromboembolism)
The risk of cardiac failure is increased in the following conditions.
One. Elderly pregnant women
Two. Past history of cardiac failure
Three. Risk factors during current pregnancy like anaemia, infection, multiple pregnancy and hypertension
Four. Lack of antenatal care
Five. Left ventricular hypertrophy
Six. Cardiac arrhythmias
Seven. Valvular heart disease
Eight. Pulmonary hypertension
Nine. Cardiomyopathy