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Pregnancy
Electrocardiogram
Left axis deviation
ST segment and T wave changes
Small Q, inverted P or T wave in lead III
Increased R wave amplitude in lead V2
Atrial or ventricular ectopics
Chest X-ray
Straightened left upper cardiac border
Horizontal heart position
Increased lung markings
Echocardiogram
Increased left/right ventricular dimensions
Mild increase in left/right atrial size
Slightly improved left ventricular systolic function
Functional tricuspid/pulmonary insufficiency
08/01/09 Small pericardial
Dr.Uma effusion
Dr.NK Gupta 16
Management areas
Areas be considered in the clinical approach to
the woman with heart disease who is pregnant
or considering pregnancy:
2) Risk stratification, Pre-conceptional
3) Antepartum management,
4) Peripartum management,
4) Recurrence of congenital lesion in the neonate,
5) Site of antepartum and peripartum care.
The criteria committee of the New York Heart Association, Nomenclature and criteria for diagnosis of diseases of heart and great vessels,
Edi 8, New York Association,1979.
08/01/09 Dr.Uma Dr.NK Gupta 24
Antepartum Care
Bates SM, Greer IA, Hirsh J, Ginsberg JS. Use of antithrombotic agents during pregnancy. Chest 2004; 126:627S–
644S
08/01/09 . Dr.Uma Dr.NK Gupta 37
Anticoagulation therapy
At week 36 #
*Discontinue warfarin
*Change to UFH titrated to a therapeutic aPTT or anti-
factor Xa level.
At Delivery:
*Restart heparin therapy 4 to 6 hr after delivery if no
contraindications
*Resume warfarin therapy the night after delivery if no
bleeding complications
#if labor begins while the woman is receiving warfarin,
anticoagulation should be reversed and caesarean
delivery performed
Ginsberg JS, Greer I, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 2001;119:Suppl:122S-131S
• Postpartum monitoring