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Adult Congenital Heart Disease - Part 2

Chăm sóc của nhóm này có nguy cơ cao của phụ nữ mang thai cần được cung cấp bởi các nhân viên được đào tạo đầy đủ, tốt nhất là ở cấp chuyên gia tư vấn. Hơn nữa, các chuyên gia tư vấn như vậy cần có kinh nghiệm hoặc đào tạo trong thời kỳ mang thai ở phụ nữ có bệnh tim | 20 Chapters infection for example urinary tract infection increased risk of subacute bacterial endocarditis hemorrhage both antepartum and postpartum hemorrhage pose particular risks for women with limited cardiac reserve arrhythmia myocardial excitability is increased during pregnancy . Antenatal care Care of this high-risk group of pregnant women should be provided by fully trained personnel preferably at consultant level. Moreover such consultants should have experience or training in pregnancy in women with cardiac disease who are best looked after in a specialist unit. Regular visits will need to be more frequent than in women with a normal pregnancy for example every 2 weeks until 24 weeks and then weekly and a much more thorough examination should be carried out at each visit than is necessary in women without medical complications. It is probably good practice at each visit to measure the pulse rate and blood pressure assess the heart rhythm auscultate the heart sounds listen to the lung bases. Such a thorough examination can pick up the early signs of pathology developing such as ventricular decompensation results in a tachycardia onset of arrhythmia the development of bacterial endocarditis incipient pulmonary edema. Prompt management before major decompensation occurs can prevent many problems. At each visit the woman should be asked specifically about any shortness of breath or palpitations. Antenatal records which we have designed specifically for the care of women with cardiac disease during pregnancy are illustrated in Fig. 3.1. Periodic echocardiography and other imaging should be individualized according to patients specific cardiovascular status. Typically close monitoring is required for patients with evidence of deteriorating cardiac function the appearance of a new murmur or those at risk of silent deterioration for example aortic root dilatation in Marfan syndrome . Because of the increased risk of congenital heart disease in the fetus it is .