The most common and the most poorly tolerated heart disease during pregnancy is:
Ans. c (Aortic stenosis). (Ref. Dutta, Obstetrics, 6th ed., p 281)# Aortic stenosis has maternal mortality of 15-20% and Perinatal loss of 30%.HEART DISEASE IN PREGNANCY# The risk of fetal congenital malformations is increased by 3-10% if either parents have congenital lesions.# In mother with ASD, risk of having concordant abnormality in baby is very much high.# Most common heart disease in pregnancy is mitral stenosis.# The most common congenital heart disease during pregnancy is ASD.# Management:a) Management of first stage of labour.i) Place the patient in lateral recumbant position.ii) As a rule the quantity of infused fluid should not be more than 75 ml/hr to prevent pulmonary edema, except in Aortic Stenosis where the fluid therapy should not be restricted and the rate of infusion should be 125-150 ml/ hr.iii) Prophylaxis with antibiotics during the labour and 48 hrs after delivery is appropriate.b) Management of second stage of labourQi) Curtail the second stage of labour (ventouse is preferable to forceps as it can be applied without putting the patient in lithotomy position and thus preventing cardiac overload).ii) Withhold IV ergometrine with delivery of anterior shoulder to prevent sudden cardiac overload.iii) It is better to prefer ergometrine than oxytocin in all cases of heart disease.- Absolute indications for termination of pregnancy are primary pulmonary hypertension, Eisenmenger's syndrome.Q- In general there is no indication of Caesarean Section for heart disease except in Coarctation Of Aorta, where elective LSCS is indicated to prevent rupture of aorta or mycotic cerebral aneurysm.Qc) Epidural anaesthesia is preferable over general anaesthesia (contraindicated in AS).d) Anticoagulant therapy is not a contraindication for breast feeding.e) Barrier method is the contraception of choice, steroidal and IUCD are contraindicated.QBest time for mitral valvotomy in pregnancy with mitral stenosis is-44-18 weeks.# Mitral stenosis is especially dangerous because the tachycardia, increased blood volume, and increased cardiac output of pregnancy interact with this lesion to elevate pulmonary capillary pressure; atrial fibrillation is also common. Together, these factors increase the risk of pulmonary edema, the most lethal complication of mitral stenosis.# Mitral valvotomy can be performed during pregnancy, but open heart surgery increases the risks of abortion and fetal damage.# Prophylactic antibiotic therapy should be continued during pregnancy.# In patients with mitral stenosis, digoxin 0.25 mg/day po is used if atrial fibrillation develops.# Labor and delivery are best tolerated at full term, and close attention to analgesia and to relief of anxiety is essential.# Generally the most hazardous time is during peak cardiac output (at 20 to 34 wk).
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Miscellaneous (Gynae)