Part 2 book “ABC of antenatal care” has contents: Antenatal medical and surgical problems, antenatal medical and surgical problems, antepartum haemorrhage, small for gestational age, preterm labour, multiple pregnancy, the audit of birth. | 8 Antenatal medical and surgical problems Pregnant women are usually young and fit. They rarely have chronic medical conditions but when they do, those in charge of antenatal care need to consider how the disease might affect pregnancy and how pregnancy might affect the disease. Heart disease Most heart disease in women of childbearing age is rheumatic in origin despite the recent great reduction in the prevalence of rheumatic fever. Better living conditions in the UK and the more prompt treatment of streptococcal sore throats with antibiotics in childhood have reduced rheumatic damage to the heart valves and myocardium. An increasing proportion of pregnant women have congenital heart lesions that have been treated previously. Pregnancy puts an increased load on the cardiovascular system. More blood has to be circulated so that cardiac output increases by up to 40% by mid-pregnancy, staying steady until labour, when it increases further. This increased cardiac work cannot be done as effectively by a damaged heart; if the heart is compromised a woman would be wise to avoid other increased loads that might precipitate cardiac failure. The most frequently encountered are: ● ● ● ● ● Household work Paid work outside the home Care of other family members Pre-eclampsia Anaemia ● ● ● ● Box • • • • • • • • • • Other 20% Recrudescence of rheumatic fever Respiratory infection Urinary infection Bacterial endocarditis Mitral valve disease 30% Aortic stenosis 15% Care should be taken just after delivery: with the uterine retraction up to a litre of blood can be swiftly shunted from the uterine veins into the general venous system. Atrial septal defect 15% Rheumatic heart disease The commonest single cardiac lesion found in women of this age group is rheumatic mitral stenosis, sometimes accompanied by the after effects of rheumatic myocarditis. The commonest complication of overload is pulmonary oedema in late pregnancy or immediately after delivery. Right-sided
