Pregnant women with heart disease diagnosis

Pregnant women with heart disease, pregnancy-induced hypertension, postpartum hemorrhage as with the three major causes of maternal deaths, should be ready pay attention. 1, pregnancy and childbirth on the impact of heart disease 1. Pregnancy in the whole blood volume during pregnancy than not pregnant, an increase of 30 percent or more, 32 to 34 weeks of pregnancy reached a peak. Cardiac output and stroke volume in the early pregnancy, that the medium-term increase in heart rate increased. As uterus during pregnancy increased gradually increased so that the diaphragm, heart shift. These changes have increased the burden on the heart. 2. Delivery of this period also increased by the equivalent manual contractions strong impact, energy consumption increased, and more heavy burden on the heart. First stage, uterine contraction increased blood circulation around the resistance and Rhodobryum roseum output. At the second stage, with the exception of uterine contractions, muscle and skeletal muscle have participated in campaigns to even greater resistance around, and maternity breath when forced to increase pressure on the pulmonary circulation, increased abdominal pressure at the same time, a short period of time visceral blood flocking to the heart, to add more burden on the heart. The third stage, when the baby is delivered after the uterus closing rapidly, abdominal pressure drop, blood stasis to the splanchnic vascular, Rhodobryum roseum sharp decline in output, or postpartum strong and sustained uterine contractions in the womb from massive blood sinusoids suddenly entered the blood circulation Rhodobryum roseum rapidly, quickly reset the heart, are poor heart function to find it difficult to adapt. 3. Puerperium 24 to 48 hours after childbirth, retention in the organization, most of the liquid return to the large number of blood circulation, so that blood volume also increased, once again increasing burden of the heart. To sum up, in 32 to 34 weeks of pregnancy and childbirth (in particular second stage) and puerperal early three days is suffering from heart disease maternal most dangerous period, then the burden is heavy heart and prone to failure endanger the mother infant life. Second, the classification of pregnancy complicated by heart disease 1. Heart of the types of rheumatic heart disease during pregnancy to heart disease and congenital heart disease more common, followed by pregnancy-induced hypertension and heart disease, such as anemia. 2. Cardiac function in the general classification to pregnant women daily physical activity is based on tolerance, heart function will be divided into four, applicable to various types of heart disease. Ⅰ level: general unrestricted physical activity. Ⅱ grade: General physical activity slightly restricted, after labor day-to-day fatigue, heart rate, shortness of breath or chest tightness, and so does not resume business as usual rest. Ⅲ grade: General physical activity significantly limited, in general day-to-day activities less physical activity that is fatigue, heart rate, shortness of breath or discomfort, such as angina pectoris, the break asymptomatic. Ⅳ class: when the rest want dysfunction symptoms, minor physical activity can add to the discomfort or discomfort, with a clear heart failure phenomenon. Third, diagnosis 1. History of newly diagnosed pregnant women should be asked in detail about whether the past history of heart disease, especially the history of rheumatic heart disease and rheumatism. Clinics in the past, such as whether heart failure. 2. Signs ① cardiac auscultation found diastolic murmur, there are general tips organic lesions. ② Ⅲ level or above grade Ⅲ systolic murmur, and the rough nature of a longer time frame should consider the diagnosis of heart disease. Diagnosis is difficult sometimes to be re-confirmed post-natal follow-up. ③ serious arrhythmia, such as atrial flutter, atrial fibrillation, atrioventricular block, a diastolic Benma law, are indications that there are cardiomyopathy, and premature beat, and paroxysmal supraventricular tachycardia can sometimes in the absence of heart disease found in pregnant women, should be aware of recognition. 3. Aided diagnosis ① conventional ECG help for diagnosis. ② Echocardiography confirmed whether contribute to pulmonary hypertension and the type of congenital heart disease. 4, processing 1. Not have organic heart disease, pregnant women of childbearing age, if the following conditions should not be pregnancy: ① cardiac function Ⅲ grade or above grade Ⅲ, mitral stenosis with severe pulmonary hypertension or more obvious cyanotic congenital heart disease patients should first repair surgery, such as surgery to surgery or not; ② rheumatic heart disease with atrial fibrillation or heart rate faster difficult to control; ③ heart expanded significantly (Hint myocardial damage or serious valve disease) or had incomplete restoration of cerebral embolism; ④ history or with heart failure had serious medical complications such as chronic nephritis, such as tuberculosis patients. These patients should be strictly contraception. 2. Pregnancy ① therapeutic abortion of pregnant women suffering from organic heart disease, if not the indication of pregnancy abortions should be done as soon as possible. Within three months of pregnancy possible absorption of the Palace, more than three months of pregnancy, should select the appropriate measures to termination of pregnancy. Pregnancy in heart failure, heart failure have to wait until after the abortion control. ② strengthen prenatal check heart function Ⅰ, Ⅱ-pregnant women can continue to pregnancy, from the first trimester prenatal care system began, the situation closely observed cardiac function. Obstetrics and medicine from the best joint custody. Ⅰ see clinical cardiac function in patients with class or grade Ⅱ pregnancy exertion or upper respiratory tract infection, it can quickly deteriorate into Ⅲ grade, and even heart failure, must be hospitalized, is not uncommon. The patients are often tense, and should be more comforting to avoid emotional fluctuations. ③ guarantee the prevention of heart failure sleep at night every day for 10 hours, day after meal breaks from 0.5 to 1 hour. Restrictions on the volume of activities, salt restriction of not more than four grams a day. Actively prevent and treat anemia, to iron, folic acid, vitamin B and C, calcium and so on. Better nutrition. Throughout pregnancy weight gain should not be more than 11 kg. ④ early detection of heart failure when the sudden drop in physical, RUF cough, accelerated heart rate, lung sustained at the end of the sound and moist cough does not disappear after, edema or weight increase of excessive growth, should be vigilant. ⑤ timely treatment of acute congestive heart failure from semi-supine to facilitate breathing and reduce output Rhodobryum roseum immediately oxygen, given tranquilizers, diuretics (usually to oral or intravenous furosemide), cardiac intravenous drug or drug-West and Mao Rotary Hanako glycosides K. Symptoms can be improved, as appropriate, and preparation of oral digoxin Gexin, 0.25 to 0.5 mg daily for the maintenance of. ⑥ timely admission even if asymptomatic, should also be in the pre-production period of two weeks before admission. For the deterioration of cardiac function during pregnancy class Ⅲ or infection should be promptly hospitalized. ⑦ have heart surgery are still dealing with the history of post-operative cardiac function depends on the situation. 3. Childbirth ① birth process should start to antibiotics, and actively prevent and treat infection. Four times daily measuring body temperature, pulse and respiration of ground. ② maternal quiet rest, can give a small amount of sedatives, intermittent oxygen, and prevention of heart failure and fetal distress. ③ If no indications of cesarean section, the vaginal delivery, but it should be as short as possible labor. Episiotomy of viable, forceps and others. Observe the situation closely cardiac function. Birth process can be extended because of increased burden on the heart, it may be appropriate to relax indications of cesarean section. Suitable to epidural anesthesia. In the event of failure to actively control to heart failure after cesarean section. ④ the baby is delivered after abdominal pressure placed sandbags to prevent sudden abdominal pressure decreased in heart failure, and immediately intramuscular injection of morphine 0.01 g or 0.2 g of sodium phenobarbital. Such as postpartum hemorrhage more than 300 ml, oxytocin intramuscularly 10 to 20 units. Blood transfusion required, care should be taken not to excessive speed. 4. Postpartum mothers should be sufficient rest. Closely observed temperature, pulse, heart rate, blood pressure and vaginal bleeding. Guard against heart failure and infection. Following the use of antibiotics. Sterilization should be considered.