Tuesday, January 17, 2017

American Heart Association updates guidelines on Managing Pregnancy in CHD Patients.

Courtesy: http://www.heartdiseaseandpregnancy.com/

AHA


With advances in surgery and medical management, more and more female children born with CHD are reaching reproductive age. The most recent statistics by AHA  estimates that 1 in 150  adults have some form of CHD.

Ability to successfully carry the pregnancy to term, intrapartum and postpartum management of these patients involve multidisciplinary coordination and monitoring.  It includes a cardiologist expert in treating CHD, a maternal-fetal medicine  specialist, heart anesthesiologists and heart surgeons. 

“Women with complex congenital heart disease were previously advised to not get pregnant because of the risk to their life,” said Mary M. Canobbio, R.N., M.N., chair of the writing committee for the new scientific statement published in the American Heart Association Journal Circulation.[1]

“Now scientific research demonstrates that with proper management in the hands of experienced cardiologists and obstetricians, these women can have successful pregnancies,” said Canobbio, who is also a lecturer at UCLA School of Nursing in Los Angeles, California.[2]


courtesy: American Heart Association.


Most common complex defects seen in practice are single ventricle, transposition of great arteries, pulmonary hypertension and aortic valve stenosis.

In pregnancy, the blood volume increases by 40%, cardiac output increases by 30-50% with heart rate increasing by 10-20 beats/min. This change in circulation dynamic is very taxing to the heart.[3] The physician needs to assess beforehand whether the heart can handle this increased load.

The strategy to manage patients with complex CHD with pregnancy begins by preconception counselling and assessing the risk to mother and fetus, which includes genetic counselling as the risk of recurrence of CHD is always real.  The clinician should assess the volume overload, tachycardia and hypercoagulable state along with the need for constant medications.

The second most important issue is the management during pregnancy, which includes the diagnostic test required, medication alteration if teratogenic and fetal screening beside the routine antenatal care in pregnancy. Blood thinners are known to be harmful to the fetus.

Low risk patients are seen by cardiologist in first and last trimester while moderate to high risk patients are evaluated each trimester at a tertiary care center by a maternal-fetal medicine specialist. Fetal echocardiography at 18-22 weeks is recommended for all patients.

Intrapartum care, access to a tertiary care center, insurance and availability of cardiologist at the time of delivery should be discussed with the patients. Each patient should have an individual plan for her delivery, according to her medical needs. Experts advice use of narcotics and epidural to limit the urge to 'push' which increases load on heart. 

Postpartum the patients should be closely monitored in a cardiac intensive care unit and monitored for volume overload in the first 24-48 hours. In some patient close monitoring is needed for 6 months because of residual effects of pregnancy.

This scientific statement also stress the need for developing and collecting data on large cohorts of patients so that preconception care outline and pregnancy complication stratified according to individual congenital malformation can be known.

“This scientific statement outlines the specific management for these high-risk patients,” Canobbio said. “What we know about the risks for these patients, what the potential complications are, what cardiologists, advanced practice nurses and other cardiac health providers should discuss in counseling these women, and once pregnant, recommendations in terms of the things we should be looking out for when caring these women.”

Full text of the article can be found here.





[1] http://circ.ahajournals.org/content/early/2017/01/12/CIR.0000000000000458
[2] http://newsroom.heart.org/news/women-with-high-risk-congenital-heart-disease-can-have-successful-pregnancies
[3] http://news.heart.org/successful-pregnancy-possible-for-some-women-with-high-risk-congenital-heart-disease-2/?utm_campaign=sciencenews16-17&utm_source=science-news&utm_medium=phd-link&utm_content=phd01-12-16

18 comments:

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  8. I am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( cabby crew ) for 3years but early this year, i loose my job because of this deadly disease called Herpes virus (HSV), I never felt sick or have any symptom, till all workers were ask to bring their doctors report, that was how i got tested and i found out that am HSV positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to Dr Isibor, that was how i contacted him and get the medication from this doctor and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact this doctor if you are herpes positive  diseases his email is: drisiborspellhome@gmail.com 
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  9. Can't still believe that i got cured from Genital Herpes through herbal treatment from Dr LUCKY who I met through the internet, I actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. Dr LUCKY send me his medicine which I took as instructed and here I am living a happy life once again, a big thanks to Dr LUCKY , I am sure there are many herbal doctors out there but Dr LUCKY did it for me, contact him on Email him; { drluckyherbalcure@gmail.com }

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  11. i visited different hospital but they gave me list of expensive drugs to treat the symptoms and never cured me. A closed friend of mine introduce me to a Herbal Doctor who cured her. I was scared to contact him because of what i experienced from fake doctors. she encouraged me and gave me his whatsapp contact,and i contacted him and i asked him series of questions, i also ask him to show me the results of those he have cured with his herbal drugs,and he gave me all the information i needed that gave me hope. He send a Herbal medicine to me that i took and it seriously worked for me. am now Hepatitis negative. God bless you for being a sincere and great man. Am so excited and am free from herpes virus. you can reach him via email;dralikaherbalhome@gmail.com or whats-app/call on +2348116570358.

    ReplyDelete
  12. God bless Dr.CHUKWU MADU for his wonderful work in my life, my name is Helen from USA, I was diagnosed of HERPES since 2016 and it has affected my life i was
    taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr CHUKWU MADU HERBALHOME how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine through UPS delivery company. I took the medicine as prescribed by him and 11 days later i tested negative for HERPES, Dr.CHUKWU MADU truly you are great,It's Good for herpes patient to please read my testimony becuase People think herpes is really a minor skin irritation,herpes has a long term effects on health and The stigma attached to this virus by ignorant people is ridiculous. do you need his help also? Why don't you contact him through his email (dr.chukwumaduherbalhome@gmail.com) or call him on +234703
    0936239, DOCTOR CHUKWU MADU CAN AS WELL CURE THE FOLLOWING DISEASE:- 1. HIV/AIDS 2. HERPES 3. CANCER 4. ALS 5. Hepatitis B AND C 6. Diabetes 7. Athrux, 8. hydrophobia 9.hpv 10 pregnancy spell and bring back your ex back 11 scabies 12. STD. 13.Kidney stone?

    ReplyDelete
  13. I am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( cabby crew ) for 3years but early this year, i loose my job because of this deadly disease called Herpes virus (HSV), I never felt sick or have any symptom, till all workers were ask to bring their doctors report, that was how i got tested and i found out that am HSV positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to Dr Isibor, that was how i contacted him and get the medication from this doctor and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact this doctor if you are herpes positive  diseases his email is: drisiborspellhome@gmail.com 
    or his WhatApp contact +2348110493039

    ReplyDelete
  14. I want to use this opportunity to thank Dr Oyagu for the grate work he has done for me and my cousin sister, I was cured from herpes virus through his herbal remedy and my cousin sisters was also cured from Cancer. This is a grate testimony for what Dr Oyagu Has done for me and my entire generation. I'm giving this testimony so that those of you out there can contact him while he keeps saving my relatives. Send him a Dm and get a better health totally. Contact him via WhatsApp +2348101755322 or Email address:oyaguherbalhome@gmail.com you can also reach him on his website https://oyaguspellcaster.wixsite.com/oyaguherbalhome

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  15. If you are reading this and you are suffering from HSV or any other disease or you want to fix your broken marriage/relationship or maybe get back with your Ex husband, Ex wife, Boyfriend or girlfriend.. thanks to__________________ [Robinson.buckler@] yahoo. com

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