PREPARED BY:CHUKWUMA I. ONYEIJE, M.DATLANTA PERINATAL ASSOCIATES:http://chukwumaonyeije.com

A copy of this lecture can also be found at:

http://onyeije.net/present

QUESTION #1:

How can you classify heart function for pregnant women?

The New York Heart Association (NYHA) Grading of Heart Functional Capacity:

CLASS INo functional limitation of

activity

Symptoms with extra ordinary physical work.

CLASS II Mild limitation of physical

activity.  

Symptoms with ordinary physical work

CLASS IIIMarked limitation of physical

activitySymptoms with less than ordinary physical work

CLASS IV Severe limitation of physical activity

Symptoms at rest

QUESTION #2:

What is the MORTALITY associated with the various cardiac lesions ?

LOW RISK:Maternal Mortality less than

1% Septal defects NYHA Functional Class I NYHA Functional Class II Patent ductus arteriosus Pulmonary / tricuspid lesions

MODERATE RISK:Maternal Mortality 5-15% NYHA class III and IV mitral stenosis. Aortic stenosis Marfan’s syndrome with normal

aorta Uncomplicated coarctation of aorta Past history of myocardial infarction

AORTIC STENOSIS (NARROW VALVE)

HIGH RISK:Maternal Mortality 25-50%

Eissenmenger’s syndrome. Pulmonary hypertension. Marfan’s syndrome with abnormal

aortic root. Peripartum cardiomyopathy.

QUESTION #3

What determines the prognosis for a woman with cardiac disease?

Prognosis Depends of Functional Status NYHA classes I and II

Do well during pregnancy Favorable prognosis Mortality rate <1%.

NYHA classes III and IV Mortality rate of 5% to 15% These patients are generally advised

NOT to becoming pregnant.

QUESTION #4:

What are the clinical criteria for diagnosing cardiac disease DURING

pregnancy ?

Criteria to diagnose cardiac disease during pregnancy: Diastolic murmurs. Severe Systolic Murmurs (grade 3). Unequivocal enlargement of heart (X-ray). Severe arrythmias

Atrial fibrillation Atrial flutter

QUESTION #5:

Cardiac Indications for Termination of Pregnancy?

(Controversial)

Cardiac Conditions With Prohibitively High Maternal

Risks:Eisenmenger’s syndrome.Marfan’s syndrome with aortic involvement

Pulmonary hypertension.Coarctation of aorta with valvular involvement.

Termination is ideally performed before 12 weeks of pregnancy.