tailieunhanh - 100 Questions in Cardiology - Part 10

Những người với phổi tăng huyết áp đáng kể (sức đề kháng mạch máu phổi 2 / 3 của hệ thống), đặc biệt là cyanotic bệnh nhân và những người có phản ứng Eisenmenger (mẹ tử vong ~ 5 | 198 100 Questions in Cardiology 93 Which cardiac patients should never get pregnant Which cardiac patients should undergo elective Caesarean section Sara Thorne Which women should never get pregnant 1 Those with significant pulmonary hypertension pulmonary vascular resistance 2 3 of systemic especially cyanotic patients and those with Eisenmenger reaction maternal mortality 50 and those with residual pulmonary hypertension after . VSD closure. NB Even women with modest pulmonary vascular disease 1 2 systemic are at risk of death. 2 Those with grade 4 systemic ventricular function EF 20 . Which women should not get pregnant until operated upon 1 Marfan s syndrome patients with aortic aneurysm dilated aortic root. 2 Those with severe left sided obstructive lesions AS MS coarctation . Which women should undergo elective Caesarean section 1 Those with independent obstetric indications. 2 Caesarean section should be strongly considered for the following women Those with mechanical valves especially tilting disc in the mitral position. The key here is to leave the mother off warfarin for the minimum time possible. An elective section is performed at 38 weeks gestation replacing the warfarin with unfractionated heparin for the minimum time possible Severe aortic or mitral stenosis. If the mother s life is at risk section followed by valve replacement may be necessary. Controversy remains over whether the following patients should undergo elective Caesarean section 1 Cyanotic congenital heart disease with impaired fetal growth. Section may help to avoid further fetal hypoxaemia but at the 100 Questions in Cardiology 199 expense of excessive maternal haemorrhage to which cyanotic patients are prone. 2 Pulmonary hypertension. See comments above. A balance has to be made between a spontaneous vaginal delivery with the mother in the lateral decubitus position to attenuate haemodynamic fluctuations forceps assistance and the smaller volume of blood lost during this type of .