Heart Disease and Pregnancy

Description

This comprehensive and authoritative text on heart disease in pregnancy - one of the leading causes of maternal death - will be of value to a wide audience of obstetricians, cardiologists, anaesthetists, midwives, and cardiac nurses. It provides consensus guidelines of great practical value in a compact and convenient format. Written by a multidisciplinary team, it covers both maternity and cardiac care. Contents range from pre-conception counselling and contraception, through practical templates for antenatal and intrapartum care, to long-term outcome for both mother and baby. It covers all causes of heart disease, both congenital and acquired. Thoroughly updated, this new edition has reorganised the consensus statements about priorities in management. In addition, each chapter now starts with a summary of 'Practical Practice Points' to aid quick revision when seeing a patient with a specific problem. A new section on heart and lung transplantation has been added since the first edition. Cover......Page 1 Half-title......Page 3 Title page......Page 5 Copyright information......Page 6 Table of contents......Page 7 List of contributors......Page 9 Preface......Page 11 Consensus statements......Page 12 Components of preconception counseling......Page 17 Informed choice and understanding......Page 18 Preparing for pregnancy......Page 19 Risk of congenital abnormality......Page 20 References......Page 21 Counseling patients on the risks of pregnancy......Page 22 Classification of cardiac conditions......Page 23 Efficacy of use of contraceptive agents......Page 24 Combined hormonal contraceptives......Page 27 Desogestrel......Page 28 Injectable progestogens (Nexplanon®—previously Implanon®)......Page 29 Barrier methods......Page 30 Pulmonary arterial hypertension......Page 31 References......Page 32 Clinical implications......Page 35 Clinical implications......Page 37 Cardiac anatomical change......Page 38 Cardiac functional change......Page 39 Clinical implications......Page 41 References......Page 42 Introduction......Page 45 Recognition of the cardiac condition......Page 46 Trivial and low-risk cardiac lesions......Page 47 What should the woman be told?......Page 48 The fetus and fetal surveillance......Page 49 References......Page 50 Introduction......Page 52 The spectrum of maternal heart disease......Page 53 Organization of antenatal care......Page 54 Recommendations for organization of antenatal care......Page 56 References......Page 58 Initial assessment of the patient......Page 59 Risk assessment......Page 60 Organizing care and monitoring......Page 61 Echocardiography......Page 63 Ventricular size and function......Page 64 Valvar abnormalities and function......Page 65 Electrocardiography......Page 66 References......Page 67 Potential adverse effects of drugs......Page 69 Thiazide diuretics......Page 70 Hydralazine......Page 71 Angiotensin II inhibitors......Page 72 Sotalol......Page 73 Beta-adrenergic receptor blockers......Page 74 Breastfeeding......Page 75 Oxytocin......Page 76 Ritodrine......Page 77 References......Page 78 Introduction......Page 81 Fetal and maternal risks of cardiopulmonary bypass......Page 82 Key points regarding cardiopulmonary bypass in pregnancy......Page 84 Radiation and contrast agent risks to fetus and mother......Page 85 Mitral valve stenosis......Page 87 Aortic valve stenosis......Page 89 Mitral or aortic regurgitation......Page 90 Dissection of the aorta......Page 91 Coronary interventions......Page 92 Congenital heart disease......Page 94 Miscellaneous interventions......Page 95 References......Page 96 The effect of prenatal diagnosis on outcome......Page 100 Level 2......Page 101 Previous affected child......Page 102 Metabolic risk factors......Page 103 Equipment required......Page 104 Counseling......Page 105 Ongoing assessment: Fetal well-being......Page 106 Fetal tachycardia......Page 107 Early detection of congenital heart disease......Page 108 References......Page 109 Maternal risk factors......Page 112 Maternal indices......Page 113 Cyanotic vs acyanotic heart disease......Page 114 Fetal surveillance......Page 115 Fetal assessment......Page 117 Women needing heart surgery in pregnancy......Page 118 References......Page 119 Tissue prostheses......Page 122 Unfractionated heparin......Page 123 Warfarin......Page 125 Low-molecular-weight heparin......Page 126 References......Page 128 Aortopathies and related conditions......Page 131 Nonaortopathy complications of Marfan syndrome......Page 132 Risk stratification......Page 133 Monitoring during pregnancy......Page 134 Delivery issues......Page 135 Hypertension......Page 136 Aneurysm formation......Page 137 Conclusions......Page 138 References......Page 139 Mitral and aortic stenosis......Page 141 Treatment......Page 142 Congenital mitral stenosis......Page 143 Prepregnancy assessment of isolated aortic stenosis......Page 144 Cardiopulmonary bypass surgery during pregnancy......Page 145 References......Page 146 Preconception evaluation and counseling......Page 147 Congenital right heart lesions......Page 148 Atrial septal defect......Page 149 Tetralogy of Fallot......Page 150 Pulmonary stenosis......Page 151 Congenitally corrected transposition of the great arteries......Page 152 Transposition of the great arteries......Page 153 Univentricular hearts after Fontan-type operations......Page 154 Summary......Page 156 References......Page 158 Definition of PH......Page 160 Pathophysiology of PH......Page 161 Making the diagnosis of PH......Page 162 The challenges of managing a pregnant patient with PH......Page 163 Management of PH in pregnancy in the pre-PAH treatment era......Page 164 Management of PH in pregnancy in the PAH treatment era......Page 166 Preconception counseling......Page 168 Monitoring the mother at delivery and in the early postpartum period......Page 171 Mode of delivery and anesthetic management......Page 172 References......Page 173 Introduction......Page 176 Pregnancy outcome......Page 177 Incidence......Page 178 Pathophysiology......Page 179 Clinical features......Page 180 Long-term management......Page 181 Mortality and prognosis......Page 182 Recurrence and risks in future pregnancies......Page 183 Hypertrophic cardiomyopathy......Page 185 References......Page 186 Introduction......Page 190 Treatment of acute coronary syndrome......Page 191 References......Page 193 Incidence of arrhythmias during pregnancy......Page 196 Mechanism of arrhythmia in women with heart disease during pregnancy......Page 197 Ventricular tachycardia......Page 198 Atrial flutter......Page 199 Electrophysiological study and catheter ablation......Page 200 Considerations with specific antiarrhythmic drugs......Page 201 Arrhythmia during pregnancy in specific categories of CHD......Page 202 Anesthetic management of women with arrhythmias during delivery......Page 203 References......Page 204 Epidemiology......Page 207 Predisposing factors......Page 208 Preventative measures......Page 209 Diagnosis......Page 212 References......Page 213 Epidemiology......Page 215 Hemodynamic changes during pregnancy......Page 216 Heart transplant physiology......Page 217 Rejection......Page 218 Death......Page 219 Surveillance during pregnancy......Page 220 References......Page 222 Significance of cardiac disease in the peripartum period......Page 224 Mode of delivery......Page 225 Third-stage management......Page 226 Regional anesthesia/analgesia......Page 227 Regional analgesia......Page 228 Disadvantages of general anesthesia......Page 229 Noninvasive cardiac output monitoring......Page 230 Equipment and environment......Page 231 References......Page 232 Hemodynamic changes......Page 234 Circulating volume changes......Page 235 Alteration in cardiac shunting of blood......Page 236 Timing of maternal deaths during the puerperium......Page 237 Valvular and aortic disease......Page 238 Multidisciplinary care during the puerperium......Page 239 Pain relief, oxygen, and posture......Page 240 References......Page 241 Introduction......Page 243 Pulmonary hypertension......Page 244 Tetralogy of Fallot......Page 245 Valvar heart disease......Page 246 Aortopathy......Page 247 References......Page 248 Introduction......Page 250 Peripartum cardiomyopathy......Page 251 Connective tissue disorders and aortopathies......Page 252 References......Page 253 Appendix A: New York Heart Association classification of cardiovascular disease......Page 256 Appendix B: Antenatal care pathway......Page 257 Index......Page 271 Colour Plates......Page 283