USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

SPECIFIC MANAGEMENT

Table I-10-1. Heart Disease in  Pregnancy

Diagnosis Problems Management

Rheumatic   mitral  stenosis ↓  diastolic   filling time ↓  HR; ↓   IV  vol

ASD,    VSD Regurgitation Conservative

Tetralogy   of  Fallot  corrected No    problem Conservative

Eisenmenger syndrome Pulmonary  HTN

Intracardiac    shunt

Avoid   hypotension

Marfan  syndrome Dilated    aortic  root

External    diameter    ≥4  cm

Surgical    reconstruction

Peripartum  cardiomyopathy Biventricular    cardiac failure Supportive  care

Antepartum. Left    lateral rest,   2   g   sodium  diet,   digitalis   as  indicated,  diuretics

as  indicated,  avoid   strenuous   activity,   avoid   anemia, fetal   echocardiogram  (if

patient has congenital  heart   disease).

Intrapartum.    Aim for vaginal delivery,   left    lateral rest,   monitor intravascular

volume, administer  oxygen, reassurance,    sedation,   SBE prophylaxis,    epidural,

no  pushing,    elective    forceps to  shorten the second  stage   of  labor,  possible

arterial    line    and pulmonary   artery  catheter    (if Class   III or  IV  status).

Postpartum. Watch   closely for postpartum  intravascular   overload    caused  by

sudden  emptying    of  uterine venous  sinuses after   placental   delivery.