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Fessehaye A, Tafere YT, Abate DD. Postpartum maternal collapse-a first-time presentation of severe mitral stenosis: a case report. J Med Case Rep 2021; 15:225. [PMID: 33941257 PMCID: PMC8092996 DOI: 10.1186/s13256-021-02806-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among cardiac causes for postpartum maternal collapse, severe mitral stenosis is not listed as a potential cause in current literature. We report a rare case of severe mitral stenosis that presented with severe hypoxia and maternal decompensation in early postpartum period for the first time. A 30-year-old para 2, abortus 1, Ethiopian woman developed severe hypoxia and rapid deterioration on her sixth postoperative day after cesarean delivery for fetal bradycardia with a good fetal outcome. She was put on a mechanical ventilator when she developed respiratory failure. Initially, a diagnosis of pulmonary embolus was considered. After admission to the intensive care unit, severe mitral stenosis was diagnosed with the help of echocardiography. She was managed successfully for congestive heart failure and discharged from the intensive care unit with improvement. CONCLUSION The possibility of mitral stenosis, as a differential diagnosis, should be considered whenever a case of postpartum maternal collapse is encountered. We recommend a routine immediate echocardiography in any patient that experiences postpartum collapse, especially in the presence of a known trigger for heart failure such as long hours of labor, bleeding, anemia, hypotension, and infection.
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Affiliation(s)
- Abraham Fessehaye
- Department of Obstetrics and Gynecology, Saint Paul's Hospital millennium Medical College, Addis Ababa, Ethiopia.
| | - Yared Teshome Tafere
- Department of Obstetrics and Gynecology, Saint Paul's Hospital millennium Medical College, Addis Ababa, Ethiopia
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Odendaal H, Groenewald C, Myers MM, Fifer WP. Maternal heart rate patterns under resting conditions in late pregnancy. ACTA ACUST UNITED AC 2018; 1. [PMID: 31008442 PMCID: PMC6474684 DOI: 10.15761/tr.1000116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives: To describe maternal heart rate patterns observed during antenatal monitoring under resting conditions between the gestational ages of 34 to 38 weeks and to demonstrate its associations with uterine activity. Methods: Each participant had five high quality ECG electrodes attached to her anterior abdominal wall which were connected to the Monica AN24 device to collect raw electrical signals from the maternal and fetal ECG and signals of uterine activity. Proprietary software was then used to download the raw data and extract the maternal and fetal heart rate patterns and uterine activity. Results: Several distinct maternal heart rate patterns were observed. These included unusually high or low levels of variability, tachycardia, bradycardia, regular and irregular periodic changes and sporadic changes where the heart rate suddenly decreased or increased. Some of the fluctuations, especially decelerations of maternal heart rate, seemed to be associated with uterine activity. Conclusion: The clinical implications of these different patterns, for both the mother and fetus, needs to be explored further. There is a need for computerized analyses of the different maternal patterns during different gestational ages to determine its relevance. Synopsis Various maternal heart rate patterns under resting conditions in late pregnancy are described.
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Affiliation(s)
- Hein Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Coen Groenewald
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Michael M Myers
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA.,Extraordinary Professor, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - William P Fifer
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA.,Extraordinary Professor, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
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3
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A Historic Case of Cardiac Surgery in Pregnancy. Case Rep Obstet Gynecol 2016; 2016:7518697. [PMID: 27803828 PMCID: PMC5075601 DOI: 10.1155/2016/7518697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall's procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion. Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature.
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Akinwusi PO, Adeniji AO, Atanda OO, Adekunle AD. Hospital-based incidence of maternal heart failure during pregnancy in Nigeria. Int J Gen Med 2013; 6:201-7. [PMID: 23589699 PMCID: PMC3625026 DOI: 10.2147/ijgm.s42326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose To determine the incidence of heart failure during pregnancy and incriminated cardiac lesions, as well as maternal and fetal outcomes in Ladoke Akintola University of Technology Teaching Hospital (LTH), Osogbo, Southwest Nigeria. Methods This study was a retrospective, descriptive review of all cases of heart failure during pregnancy based on data retrieved from the medical records of LTH over a 7-year period from January 2004 to December 2010. Analysis of these data was carried out using SPSS 17. Ethical clearance was obtained from the Ethical Committee of LTH. Results A total of 4523 patients delivered babies over the 7-year period, ten (2.2/1000) of which had cardiac decompensation. All patients were not registered at LTH for antenatal care (unbooked), with 70% of them aged 18–24 years. Fifty percent were primigravidae and the majority of them presented with symptoms in the second and third trimester. There were two cases of maternal deaths recorded and three cases of fetal/perinatal mortality. Only one case of congenital heart disease (pulmonary stenosis) and no cases of rheumatic heart disease were found. Conclusion The data suggests that heart failure during pregnancy is uncommon in Southwest Nigeria. However, it occurs more often in young, unbooked primigravid women. Efforts should be aimed at encouraging early booking for antenatal care and a full cardiovascular evaluation to prevent associated maternal and fetal/perinatal morbidity and mortality.
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Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University ; Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
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Reyes O LE, Muñoz L, Maldonado CE. Pulmonary embolectomy and cardiopulmonary bypass during pregnancy. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Reyes O. LE, Muñoz L, Maldonado CE. Embolectomía pulmonar y bypass cardiopulmonar durante el embarazo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bliacheriene F, Avila WS, Bortolotto MRFL, Okano FT, Fontes ES, Galas FRBG, Carmona MJC. Anesthesia for cardiac surgery under cardiopulmonary bypass in pregnant patients: experience with nine cases. Int J Obstet Anesth 2012; 21:388-9. [PMID: 22922088 DOI: 10.1016/j.ijoa.2012.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/13/2012] [Accepted: 06/17/2012] [Indexed: 11/26/2022]
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Abstract
Advances in the surgical palliation and correction of congenital heart lesions have improved survival and increased the number of patients living into adulthood. Although pregnancy outcomes will be favorable for most patients with congenital heart disease, the cardiovascular challenges associated with pregnancy and delivery are best managed with a multidisciplinary approach during the puerperium. This review addresses the prevalence, physiology, risk assessment, peripartum complications, and anesthetic management of the pregnant patient with underlying congenital heart disease.
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Affiliation(s)
- Amy J Ortman
- University of Kansas Medical Center, Kansas City, KS 66160-7415, USA.
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9
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Wolff GA, Weitzel NS. Management of acquired cardiac disease in the obstetric patient. Semin Cardiothorac Vasc Anesth 2011; 15:85-97. [PMID: 21994133 DOI: 10.1177/1089253211420302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiologic changes incurred by pregnancy can cause severe decompensation in the parturient with underlying cardiac disease. The result is increased morbidity and mortality for both mother and child. Appropriate anesthetic management can significantly impact these outcomes. This review systematically presents the pathophysiology, peripartum risk, and anesthetic management in the puerperium of specific acquired cardiac abnormalities including: valvular disease, pulmonary hypertension, cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and cardiac arrest.
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Abstract
Premature delivery of an infant is occasionally performed because of complications of pregnancy. This article reviews common medical indications for preterm delivery and the available evidence supporting delivery before 37 weeks of gestation. In many conditions, few data exist to guide optimal timing of delivery and management is guided by expert opinion. Ultimately, an individual assessment must be made in each case to weigh the risks that pregnancy continuation poses to the mother and/or fetus with the risks of prematurity and its associated morbidities.
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Affiliation(s)
- Amy E Wong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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11
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Kuklina E, Callaghan W. Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA: 1995-2006. BJOG 2010; 118:345-52. [PMID: 21091604 DOI: 10.1111/j.1471-0528.2010.02743.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES to describe changes in characteristics of delivery and postpartum hospitalisations with chronic heart disease from 1995 to 2006. DESIGN cross-sectional study. SETTING USA, nationwide hospital discharge data. POPULATION a total of 47 882 817 delivery hospitalisations and 660 038 postpartum hospitalisations. METHODS adjusted odds ratios describing the associations between chronic maternal heart disease and severe obstetric complications were obtained from multivariable logistic models. The contribution of chronic heart disease to severe morbidity was estimated using adjusted population-attributable fractions. MAIN OUTCOME MEASURES prevalence and trends in chronic heart disease, rate and risk of severe obstetric complications. RESULTS in 2004-2006, about 1.4% of delivery hospitalisations were complicated with chronic heart disease. No substantial changes in the overall prevalence of chronic heart disease among hospitalisations for delivery were observed from 1995-1997 to 2004-2006. Even so, a linear increase was found for specific congenital heart disease, cardiac dysrhythmias, and cardiomyopathy and congestive heart failure (P < 0.01). During this same period the rate of postpartum hospitalisations with chronic heart disease tripled (P < 0.01). Severe complications during hospitalisations for delivery among women with chronic heart disease were more common in 2004-2006 than in 1995-1997. In 2004-2006, 64.5% of the cases of acute myocardial infarction, 57.5% of the instances of cardiac arrest/ventricular fibrillation, 27.8% of in-hospital mortality and 26.0% of the cases of adult respiratory distress syndrome were associated with hospitalisations with chronic heart disease. CONCLUSIONS in the USA chronic heart disease among women hospitalised during pregnancy may have increased in severity from 1995 to 2006.
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Affiliation(s)
- Ev Kuklina
- Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
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Tobler D, Fernandes SM, Wald RM, Landzberg M, Salehian O, Siu SC, Colman JM, Sermer M, Silversides CK. Pregnancy outcomes in women with transposition of the great arteries and arterial switch operation. Am J Cardiol 2010; 106:417-20. [PMID: 20643256 DOI: 10.1016/j.amjcard.2010.03.047] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 12/31/2022]
Abstract
There is a growing population of young women of child-bearing age with complete transposition of the great arteries (TGA) who have had an arterial switch operation (ASO). Pregnancy imposes a hemodynamic stress on the heart and, therefore, adverse cardiac events can occur during this period; however, pregnancy outcomes in this population have not been well studied. We sought to describe cardiac outcomes during pregnancy in women with TGA who had undergone an ASO in childhood. Women were identified from 2 large tertiary care hospitals. A retrospective chart review was performed to determine the prevalence of adverse maternal cardiac events during pregnancy. Overall, 74 women of child-bearing age were identified, 9 of whom had 17 pregnancies. There were 4 miscarriages. Six women (67%) had clinically important valve (n = 5) and ventricular (n = 1) lesions before the index pregnancy. Two women developed cardiac complications during pregnancy; 1 woman with impaired left ventricular systolic function had nonsustained ventricular tachycardia and 1 woman with a mechanical systemic atrioventricular valve developed postpartum valve thrombosis. There were no maternal deaths. In conclusion, young women with TGA from this early cohort repaired with ASO are reaching child-bearing age. A significant proportion have residua and/or sequelae that can confer risk for adverse cardiac events in pregnancy. Co-ordinated care between a congenital heart disease specialist and a high-risk obstetrician should be implemented.
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Affiliation(s)
- Daniel Tobler
- Division of Cardiology, The University of Toronto Pregnancy Heart Disease Program and the Toronto Congenital Cardiac Centre for Adults, Toronto General and Mount Sinai Hospitals, Toronto, Canada
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13
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Abstract
Mitral stenosis is a common disease that causes substantial morbidity worldwide. The disease is most prevalent in developing countries, but is increasingly being identified in an atypical form in developed countries. All treatments that increase valve area improve morbidity. Mortality improves with surgery; the benefit of percutaneous balloon valvuloplasty to mortality might be similar to that of surgery but needs further study. Percutaneous balloon valvuloplasty is the treatment of choice for patients in whom treatment is indicated, except for those with suboptimum valve morphology, and even these patients are sometimes treated with this procedure if surgery is not feasible or if surgical risk is prohibitive. We review the pathology, diagnosis, and treatment options for patients with mitral stenosis.
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Affiliation(s)
- Y Chandrashekhar
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN 55417, USA.
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15
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Sachse K, Hannallah M. The anesthetic management for cesarean delivery in a patient with Shone's syndrome. Anesth Analg 2008; 107:1652-4. [PMID: 18931228 DOI: 10.1213/ane.0b013e3181864d6e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Shone's syndrome is a rare congenital cardiac condition that consists of up to four obstructive left-sided cardiac lesions. We report a 17-yr-old nullipara with Shone's syndrome who presented for cesarean delivery. She had mild mitral stenosis and mild left ventricular outflow tract obstruction. Epidural anesthesia was attempted, but the patient developed severe hypotension associated with fetal bradycardia necessitating immediate cesarean delivery under general anesthesia. The peripartum anesthetic and management considerations for these patients are discussed.
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Affiliation(s)
- Kathleen Sachse
- Department of Anesthesiology, Georgetown University School of Medicine, Washington, DC, USA
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Uebing A, Gatzoulis MA, von Kaisenberg C, Kramer HH, Strauss A. Congenital heart disease in pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:347-54. [PMID: 19629245 DOI: 10.3238/arztebl.2008.0347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 01/15/2008] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Pregnancy, birth, and the puerperium are associated with significant physiological changes and adaptations in the cardiovascular system, which pose a significant risk to pregnant women with congenital heart disease (CHD). Thanks to advances in pediatric cardiac surgery and cardiology the majority of children with CHD survive to adulthood, and an increasing number eventually become pregnant. In fact, cardiac disease - mostly congenital - is now a leading cause of maternal death in western industrialized countries. METHODS Selective literature review. RESULTS AND DISCUSSION Optimal care of women with CHD before, during, and after pregnancy requires a multidisciplinary team including obstetricians, cardiologists, and anaesthetists. Successful pregnancy at a minimum risk is feasible for most women with CHD when appropriate counseling and optimal care are provided.
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Andrade SE, Raebel MA, Brown J, Lane K, Livingston J, Boudreau D, Rolnick SJ, Roblin D, Smith DH, Dal Pan GJ, Scott PE, Platt R. Outpatient use of cardiovascular drugs during pregnancy. Pharmacoepidemiol Drug Saf 2008; 17:240-7. [DOI: 10.1002/pds.1550] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Burkart TA, Kron J, Miles WM, Conti JB, Gonzalez MD. Successful Termination of Atrial Flutter by Ibutilide During Pregnancy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:283-6. [PMID: 17338730 DOI: 10.1111/j.1540-8159.2007.00664.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sustained atrial fibrillation and atrial flutter during pregnancy are uncommon arrhythmias that can significantly complicate normal prenatal care. Direct current external cardioversion is the current method of terminating these arrhythmias. In practice, however, this technique is sometimes considered undesirable by both physician and patients due to the need for deep sedation or anesthesia. In the present study, we describe the use of ibutilide to safely terminate symptomatic persistent atrial flutter in a patient during her 24th week of pregnancy.
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Affiliation(s)
- Thomas A Burkart
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida Health Science Center, Gainesville, Florida, USA.
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Reimold SC, Forbess LW. Pharmacologic Options for Treating Cardiovascular Disease During Pregnancy. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The successful pediatric management of congenital heart disease has resulted in increasing numbers of these patients in the reproductive age group and increasing clinical challenges for their physicians. These challenges can be met successfully, with improved results for mother and child, through a concerted comprehensive team approach that relies on a thorough understanding of the patient's underlying cardiac pathology and its anticipated interaction with the pregnancy, and ongoing close evaluation and communication with a team of trained and experienced specialist, including (but not limited to) cardiologist, obstetricians, anesthetists, pediatricians, clinical nurse specialists, and clinical geneticists. Such teams are not always available locally and it will be necessary to refer medium- and high-risk patients to a specialized tertiary care center.
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Affiliation(s)
- Henryk Kafka
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Stoneham AE, Graham J, Rozanski EA, Rush JE. Pregnancy-Associated Congestive Heart Failure in a Cat. J Am Anim Hosp Assoc 2006; 42:457-61. [PMID: 17088393 DOI: 10.5326/0420457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 4-year-old, late-term pregnant Himalayan queen was diagnosed with biventricular congestive heart failure characterized by pleural effusion and pulmonary edema. A cesarean section was performed, resulting in the birth of four live kittens, with one surviving to discharge. Congestive heart failure resolved rapidly following surgery. The queen remained asymptomatic for 9 years postoperatively. Volume expansion secondary to pregnancy was thought to result in cardiovascular volume overload and subsequent congestive heart failure.
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Affiliation(s)
- Anne E Stoneham
- Department of Clinical Sciences, School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, Massachusetts 01536, USA
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Abstract
Peripartum cardiomyopathy is a rare and potentially lethal cardiac complication of pregnancy occurring in the final month of pregnancy through the first 5 months after birth. It is characterized by the development of congestive heart failure and left ventricular systolic dysfunction, in previously healthy women with no other identifiable cause for heart failure. The etiology of peripartum cardiomyopathy is not well understood. Potential causal mechanisms include infection, autoimmune disease, and abnormal response to the hemodynamic stresses of pregnancy. There is significant risk of reoccurrence in subsequent pregnancies. The purpose of this article is to review the pathophysiology, diagnosis, management, prognosis, and nursing implications of peripartum cardiomyopathy.
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Affiliation(s)
- Denise G Palmer
- Maternal-Fetal Medicine Service, University of Minnesota Medical Center Fairview, Riverside Campus, MB 450, 2450 Riverside Ave, Minneapolis, MN 55454, USA.
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Abstract
Cardiac disease complicates approximately 1% to 3% of pregnancies and is responsible for 10% to 15% of maternal mortality. The number of women of childbearing age with congenital disease is increasing as advances in diagnosis and treatment improve survival rates and overall health, allowing successful pregnancy. Pregnant women with severe cardiac disease or women who experience a cardiac event during pregnancy will require admission and stabilization in an adult critical care unit. This group of patients can prove challenging for the obstetrical staff and the critical care staff because they require blending of the knowledge and skills of 2 highly specialized areas of healthcare. The key component to a comprehensive and organized approach to management that ensures the best possible outcome for the woman is a multidisciplinary team that devises a plan on the basis of the most current information, communicates with each other and the patient effectively, and assumes responsibility for implementation of the plan. The purpose of this article is to review management of the woman with cardiac disease throughout pregnancy.
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Abstract
PATHOPHYSIOLOGY Critical care in obstetrics has many similarities in pathophysiology to the care of nonpregnant women. However, changes in the physiology of pregnant woman necessary to maintain homeostasis for both mother and fetus, especially during critical illness, result in complex pathophysiology. Understanding the normal physiologic changes during pregnancy, intrapartum, and postpartum is the key to managing critically ill obstetric patients with underlying medical diseases and pregnancy-related complications. HEMODYNAMIC MONITORING When the pathophysiology of critically ill obstetric patients cannot be explained by noninvasive hemodynamic monitoring and the patient fails to respond to conservative medical management, invasive hemodynamic monitoring may be helpful in guiding management. Most important, the proper interpretation of hemodynamic data is predicated on knowledge of normal values during pregnancy and immediately postpartum. Invasive hemodynamic monitoring with pulmonary artery catherization has been used in the obstetric population, particularly in patients with severe preeclampsia associated with pulmonary edema and renal failure.
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Affiliation(s)
- Shigeki Fujitani
- UCLA-VA Greater Los Angeles Program, Infectious Disease Section 111F, Los Angeles, CA, USA
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25
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van Mook WNKA, Peeters L. Severe cardiac disease in pregnancy, part I: hemodynamic changes and complaints during pregnancy, and general management of cardiac disease in pregnancy. Curr Opin Crit Care 2005; 11:430-4. [PMID: 16175029 DOI: 10.1097/01.ccx.0000179807.15328.f0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Part I of this review gives an overview of the hemodynamic changes that occur in normal pregnancy, the approach to the pregnant patient with complaints during pregnancy, and the general management of cardiac disease in pregnancy. RECENT FINDINGS The maternal circulatory adaptation to pregnancy consists almost entirely of adaptive changes in the maternal cardiovascular system in response to a primary systemic vasodilatation. Conversely, hemodynamic maladaptation consists of a combination of absence of these changes with signs of sympathetic dominance in the autonomic control of the cardiovascular system. SUMMARY The hemodynamic changes of normal pregnancy per se have profound effects on preexisting cardiac function. Counseling of and care for this subset of patients are challenging for the obstetrician, cardiologist, anesthesiologist and, sometimes, the intensivist to optimize maternal and neonatal survival.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care and Internal Medicine , University Hospital Maastricht, Maastricht, Netherlands.
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