gestational heart disease can be divided into two categories. The first kind is originally existing heart disease with rheumatoid and congenital heart disease, heart disease, high blood pressure in the majority, mitral valve prolapse and hypertrophic heart disease rare. The second is by pregnancy induced heart disease, such as heart disease, high levy uteruses the perinatal period heart disease.
heart disease pregnant guardianship
1, termination of pregnancy indications: the original women with heart disease can>
2, continuing the pregnancy guardianship: heart failure is heart disease pregnant women, and cardiac load fatal already declaration by plasma capacity and physiological changes such as increased consumption of compensatory exacerbated impairment and led to its main links in heart failure. Therefore, strengthening the aims to prevent pregnancy monitoring, and specific measures for heart failure can be summarized in order to alleviate the burden and improves heart heart compensatory function two.
(1) reduce heart burden: we should pay attention to the following several aspects:
1) limit physical activity. Add time to rest, daily at least 10 to 12 hours assuring morpheus. Try to take left lie a to increase the quantity and the heartbeat out come the stability of health keeping.
2) maintain spirit cable car glides, avoid emotion.
3) into high protein, less fat, much vitamin diet. Limit sodium intake, daily salt 3 ~ 5g case edema. Reasonable nutrition, control weight gain speed, make no more than 0.5 kg per week, the whole pregnancy does not exceed 10kg.
4) eliminate damage factors, such as heart anemia, hypoalbuminemia, vitamin especially B1 lack, infection, pregnancy-induced hypertension syndrome.
5) if you need a blood transfusion, many small (150 ~ 200ml); If you need rehydration, limit from 500 ~ 1 000ml/d, dripping speed & lt; 10 ~ 15 drops/minutes.
(2) improve cardiac decompensation function: including the following aspects:
1) cardiovascular surgery: the heavier conditions, the heart Ⅲ ~ Ⅳ level, surgery is not complicated, anesthesia in high requirement not pregnancy 3 ~ 4 months. Emergency mitral separation technique (pure mitral stenosis cause acute pulmonary edema) can be in prenatal implementation. Not closed artery catheter occurring during heart failure patients, or have artery catheter infections, a surgical indications.
2) of the pregnant woman: heart disease digitalis if no signs and symptoms of heart failure, the general don't need treatment, because right now the application of r. r. the yankees ineffective. Besides the pregnancy application digitalis cannot guarantee intrapartum not heart failure occurs, once react with drugs caused by then add difficulties. Furthermore, the yankees can quickly digitalis in a few minutes to produce effect, such as closely observe condition changes, it's not difficult to control in time early heart failure. So, usually only in heart failure aura symptoms or early heart failure, heart function of Ⅲ level 28 ~ 32 weeks gestation hemodynamic during pregnancy (i.e. the peak load prior) application digitalis. Due to the pregnant women poor digitalis tolerated, easy to poisoning, therefore appropriate chooses rapid preparations, such as to MaoHua sildenafil acetylation quercetin (Syria) or poison MaoHua glucoside K poison (poison MaoXuan hanako glucoside K). Maintenance treatment chooses drain faster digoxin, general use to postpartum 4 ~ 6 weeks so normal circulation.
in addition, the heart of Ⅰ grade, Ⅱ level should be increased antenatal examination pregnant women often, 20 weeks ago by heart medicine at least every two weeks, obstetrician check once, when necessary, after weekly family follow-up. In addition to observe the obstetric situation compensatory function and main understand heart of symptoms. Regularly make the electrocardiogram, echocardiography, eli told a comprehensive estimate, illness abnormal, have heart failure aura, immediately in the hospital. Two weeks before the due date, both to hospital by Labour rest adequately, also facilitate inspection observation. Once Ⅲ level and have function of heart failure should be hospitalized, and leave courtyard waiting for delivery.
during delivery and the processing
1, delivery mode choice: heart disease pregnant childbirth way, basically depends on cardiac condition and obstetrics situation.
(1) cesarean section: cesarean section can end in shorter time, thus to avoid long time delivery of uterine contraction caused hemodynamic changes, relieve fatigue and pain caused cardiac load. In addition, in continuous epidural anesthesia operation process, pregnant women blood pressure, mean arterial pressure, and heart rate changes by vaginal delivery which is for small. However, surgery increase the opportunity infection and bleeding, operation itself is a kind of burden. Therefore, when there TaiWei obstetric cause abnormal (such as when etc), fetus larger, can relax appropriately cesarean section indications, but only in cardiac Ⅲ ~ Ⅳ level, active rheumatic fever, pulmonary hypertension or pulmonary congestion, the aorta such circumstances, do selective cesarean section. Preoperative cardiac monitoring, intraoperative and postoperative, postoperative anti-infection, etc. Is the guarantee surgical safety indispensable important measures.
(2) vaginal delivery Ⅰ ~ Ⅱ level, cardiac function, those in principle, unless there is a maternity complications after vaginal delivery. Heart disease pregnant women on average, compared with normal labor no obvious difference, but must be closely monitoring by the specialist is responsible. Clinical namely after chosing antibiotic prevent infection, make the expectant mothers take half a lie bits, and give oxygen. Such as contractions, strong pain bear hard, can be set (DuLengDing) for amisulpiride 100mg intramuscular; 50 ~ Can also adopt continuous peridural anesthesia, can alleviate pain, and for a second the processing of labor. Close observation of the heart rate and breathing rate, first in every hour of labor, test the; The second test of every 10 minutes of labor once. Contractions intermittent period, such as heart rate & gt; 100 times/points or both lungs bottom appear petty wet go with mild sound and shortness of breath, but severe heart failure, shall be immediately on the aura of tyre, vein digitalis MaoHua glucoside or to injection acetylation MaoHua glucoside K poisoned. Waiting mouth open, the palace of high fetal head right namely appropriate, midwifery labor to shorten the second operation. Congenital heart disease who have left to right shunt more should avoid breathless action. Fetal childbirth immediately after the former shoulder muscles injection morphine 10u 10mg, oxytocin. The placenta, abdominal pressure after childbirth ShaDai (1kg heavy). Closely monitor blood pressure, pulse and uterine contraction become situation. Record vaginal bleeding.
2, due to strengthen puerperium processing points: pregnancy and intrapartum care, patients can smoothly. But, if puerperium, it is very relaxing guardianship may have failed. According to statistics 75% heart disease maternal death occurred in ChanRu early.
(1) continue to use antibiotics to prevent infection, to prevent subacute bacterial endocarditis occurs.
(2) had heart failure of lactation, should continue to take strong heart drugs.
(3) note body temperature, pulse, respiration and blood pressure changes, uterine contraction after and bleeding.
(4) postpartum bed rest 24 ~ 72 hours, the severe heart disease should take half a lie a maternal in order to reduce the blood, and oxygen come. If no hf performance, encourage early up activities. Have heart failure, the bed rest who should be activities during the lower extremities, in case thrombophlebitis.
(5) cardiac Ⅲ + puerpera, postpartum don't teach a breast. Breastfeeding increases the body metabolism and fluid amount need, can make the illness.
(6) postpartum at least 2 weeks, hospitalization for heart function after hospital discharge can only improve. After discharge still need rest adequately, limit activity. Strict contraception.
heart failure treatment principle
pregnancy with heart failure with the pregnancies heart failure treatment principle similar.
(1) strong heart: the application of fast to improve the preparation of myocardial status digitalis. Preferred to MaoHua glucoside, with 0.4 acetylation 20ml 25% glucose liquid with mg, slow intravenous, when need 2 ~ 4 hours later add 0.2 ~ 0.4 mg, total amount available to 1.2 mg. Also can use poison MaoHua glucoside K, 0.25 mg plus 25% 20ml, slow glucose liquid intravenous, when need 2 ~ 4 hours before injection 0.125 ~ 0.25 mg, appropriate of the capacity of 0.5 mg digitalis. Work to take after discharge faster digoxin to maintain. For the women of the digitalis strong heart medicine tolerated is bad, need to closely observe a non-toxic symptoms.
(2) diuresis: common tucked meters 40 ~ 60mg diaminofurazan intravenous to diuresis and reduce cycle blood volume and alleviate pulmonary edema. Reusable, but need to pay attention to balance the electrolyte.
(3) extender vascular: heart failure, a peripheral vascular contraction enhancement, cause cardiac load increases, application expansion after ldquo vascular medicine can up &; Rdquo; within bloodletting & Role. Choose nitric acid esters 5 ~ 10mg sorbic vision, Qiu armour c auxiliary peptide 12.5 mg or perospirone 1mg paclobutrazol work, 3 times a day.
(4) calm: small doses of morphine (diluted 5mg), not only have intravenous sedation, acetanilide, inhibit excessive excited breathing central and peripheral vascular, reduce heart expand before, and can load function arrhythmias, often used for acute left heart failure, pulmonary edema rescue.
(5) reduce the zhenjin vein HP: use a tourniquet pressurized limb, every 5 minutes turns loose solution a body. Half a lie bits and double sufficient droop available on the same role.
(6) antiarrhythmic: arrhythmias can also caused by heart failure, heart failure, or aggravated induced should rectify serious. Rapid atrial ectopic rhythms, safe and effective, with electric shocks cardioerter KuiNiDing, general lu also choose lignocaine amide etc. Rapid ventricular ectopic rhythms multi-purpose lidocaine, hydrochloric acid beautiful west law (slow rhythm of the heart), dilantin sodium, the latter especially applicable regards glutinosa severely. Height or complete atrioventricular block in principle, installation also temporary pacemaker intravenous injection isopropyl base epinephrine.
