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Management of Medical
and Surgical Conditions
in Pregnancy
Chapter 14
Karen C. Wheeler, MD
CARDIOVASCULAR CONDITIONS
❍ What is the leading cause of death in women ages 25 to 44?
Cardiovascular disease.
❍ Cardiac output increases by how much in pregnancy?
50%.
❍ What is the most common heart murmur in pregnancy?
Systolic flow murmur.
❍ What changes occur in the EKG in pregnancy?
15 degree left axis deviation and mild ST changes in the inferior leads due to elevation of the diaphragm, and
increased frequency of premature atrial and ventricular contractions.
❍ What are predictors of cardiac complications in pregnancy?
(1) Prior heart failure, transient ischemic attack (TIA), arrhythmia, or stroke
(2) Baseline NYHA class III or IV disease or cyanosis
(3) Left-sided obstruction (mitral valve area <2 cm^2 , aortic valve area <1.5 cm^2 , or peak left ventricular outflow
tract (LVOT) gradient above 30 mmHg)
(4) Ejection fraction <40%
❍ Is delivery by cesarean indicated for patients with class I or II heart disease?
No. Vaginal delivery and induction of labor are considered safe in class I and II heart disease.
❍ Is delivery by cesarean indicated for patients with class III or IV heart disease?
No. Cesarean delivery should be performed only for obstetric indications.