••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^133
❍ While pregnancy may be attempted after surgical repair of congenital cyanotic heart defects, what are some
of the risks?
Preterm delivery, miscarriage, worsening of maternal heart disease (heart failure, arrhythmias), and maternal death.
❍ What are the causes of pulmonary hypertension in reproductive aged women?
Idiopathic, collagen vascular disease, left-sided heart disease, and interstitial lung disease.
❍ Is pregnancy recommended for women with pulmonary hypertension?
Only if mild and not idiopathic, or primary pulmonary hypertension.
❍ Are there any special considerations with mitral valve prolapse in pregnancy?
If there is valvular damage or regurgitation, consider prophylaxis for bacterial endocarditis.
❍ What are the diagnostic criteria for peripartum cardiomyopathy?
(1) Development of cardiac failure in the last month of pregnancy or within 5 months after delivery
(2) Absence of an identifiable cause for the cardiac failure
(3) Absence of recognizable heart disease prior to the last month of pregnancy
(4) Left ventricular systolic dysfunction demonstrated by classic echocardiographic criteria such as depressed
shortening fraction or ejection fraction
❍ What conditions are commonly associated with peripartum cardiomyopathy?
Chronic hypertension, preeclampsia, obesity, and myocarditis.
❍ What are presenting symptoms of peripartum cardiomyopathy?
Dyspnea, orthopnea, cough, palpitations, and chest pain.
❍ How is peripartum cardiomyopathy managed?
Diuresis, afterload reduction, prevention of thromboembolism, and supportive care to maintain oxygenation.
❍ What is the most important prognostic factor for women with peripartum cardiomyopathy?
Return of left ventricular ejection fraction to >50% within 6 months.
❍ What types of dental procedures require antibiotic prophylaxis for certain women?
Procedures that involve manipulation of the gingiva, oral mucosa, or periapical tooth region.
❍ Women with what types of cardiac conditions require antibiotic prophylaxis for invasive dental procedures?
Prosthetic heart valves or prior history of infective endocarditis, prosthetic material used for repair of congenital
heart defects for 6 months after repair or if residual defect adjacent to the prosthetic material, and unrepaired
cyanotic congenital heart defects.
❍ Is antibiotic prophylaxis indicated during delivery for women with prosthetic heart valves?
Only if active infection or suspected bacteremia.