tailieunhanh - Heart Disease in Pregnancy - part 9

Trung ương huyết động giám sát gây tê ngoài màng cứng duy trì áp lực điền hỗ trợ sinh ngã âm đạo mổ lấy thai cung cấp beta-adrenergic phong tỏa ngoài màng cứng hoặc sử dụng thuốc giảm đau nói chung | 286 Chapter 19 Table Special management considerations in the critically ill gravidas Aortic dissection rupture risk Marfan syndrome Ehlers-Danlos syndrome Coarctation Takayasu s aortitis Epidural Beta-adrenergic blockade-pressure Elective cesarean delivery preferred Assisted vaginal delivery Fixed cardiac output Avoid hypovolemia Aortic stenosis Hypertrophic cardiomyopathy Pulmonary hypertension Central hemodynamic monitoring Epidural maintain filling pressures Assisted vaginal delivery Cesarean delivery epidural or general analgesia Aggressive use of pulmonary vasodilators in pulmonary hypertension Avoid pulmonary edema Mitral stenosis Beta-adrenergic blockade tachycardia Epidural Central hemodynamic monitoring Maintain wedge pressure 14-20 mmHg Assisted vaginal delivery Elevate head of bed immediately after delivery Shunt lesions Eisenmenger syndrome Tetralogy of Fallot unrepaired F series prostaglandin contraindicated Sympathetic agent contraindicated Intravenous line filters Monitor systemic saturation Vaginal delivery preferred Aggressive use of pulmonary vasodilators3 Aggressive blood loss management Labour opioid epidural Cesarean indicated monitored recovery for 10 days has been recommended aA note on pulmonary vasodilators employ inhaled nitric oxide iNO alongside prostacyclin analogues iNO via facemask or nasal cannula to final alveolar concentrations of 5-40 . and iloprost diluted in NaCl at 20 itg 2 ml up to six times daily or prostacyclin infusion of 1-10 ng kg per min up to 60 Ltg surrounds the appropriate management of patients with mechanical valve replacement. The benefits of warfarin with its superior efficacy over heparin have to be weighed against the risk of warfarin embryopathy19-22 see Chapters 7 and 9 . Lastly patients with Marfan syndrome Ehlers-Danlos syndrome coarctation of the aorta even after repair or Takaysau s aortitis are at the greatest risk for aortic dissection or rupture Table . Management of gravid .