EXPLORE

• Heart disease and Respiratory problems is a common cause of mortality and morbidity during pregnancy
• Pregnancy can exacerbate known cardiovascular disorder and unmask previously unrecognized problems
• Symptoms of heart failure in pregnant woman are indicators for urgent assessment to establish a diagnosis and appropriate management
• Trends increasing cardiovascular risk in pregnancy


  • Maternal age at first pregnancy is increasing
  • Survival in congenital heart disease has improved
  • Cardiovascular risk factors are developing at younger ages
• Maternal morbidity and mortality are increasing, with cardiovascular diseases accounting for one quarter peripartum and postpartum deaths
• Rates of maternal mortality from cardiovascular disease are highest among low-income women and women of color
• The emergence of new cardiovascular complications during pregnancy is often considered a failed stress test and can increase the risk of future cardiovascular diseases
• Women should be monitored closely after pregnancy in order to improve maternal outcomes and prevent the development of future cardiovascular disease
• Acquired valvular disease


  Can lead to complications during pregnancy owing to hemodynamic changes
• Primary pulmonary hypertension


  Can cause right heart failure
• Women with severe pulmonary hypertension have the highest maternal death rate, approaching 50%, which is attributed to high fixed pulmonary vascular resistance and an inability to increase pulmonary blood flow
• Given the high risk, most providers and guidelines recommend against pregnancy for women with established pulmonary hypertension
• Pre-existing hypertension


  A physiologic drop in blood pressure in pregnancy may allow women with preexisting hypertension to avoid medication use early in pregnancy, although they should be monitored closely
• Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and direct renin inhibitors

  Contraindicated in pregnancy
• Pregnancy-induced hypertension (PIH)


  A condition in which vasospasm occurs during pregnancy in both small and large arteries
• PIH tends to occur most frequently in women of color or with a multiple pregnancy, primiparas younger than 20 years or older than 40 years, women from low socioeconomic backgrounds, those who have had five or more pregnancies, those who have hydramnios, or those who have an underlying disease such as heart disease, diabetes with vessel or renal involvement, and essential hypertension
• Gestational hypertension


  Blood pressure 140/90 or systolic pressure elevated 30 mm Hg or diastolic pressure elevated 15 mm Hg above prepregnancy level; no proteinuria or edema; blood pressure returns to normal after birth
• Mild pre-eclampsia


  Blood pressure 140/90 or systolic pressure elevated 30 mm Hg or diastolic pressure elevated 15 mm Hg above prepregnancy level; proteinuria of 1–2 on a random sample; weight gain over 2 lb per wk in second trimester and 1 lb per wk in third trimester; mild edema in upper extremities or face
• Severe pre-eclampsia


  Blood pressure of 160/110; proteinuria 3–4 on a random sample and 5 g on a 24-hour sample; oliguria (500 mL or less in 24 hours or altered renal function tests; elevated serum creatinine more than 1.2 mg/dL); cerebral or visual disturbances (headache, blurred vision); pulmonary or cardiac involvement; extensive peripheral edema; hepatic dysfunction; thrombocytopenia; epigastric pain
• Eclampsia


  Seizure or coma accompanied by signs and symptoms of pre-eclampsia
• Asthma


  Characterized by acute airway inflammation, bronchoconstriction and increased production of mucus which can be triggered by extrinsic factors or allergens such as dusts, food, and intrinsic factors such as air pollution, tobacco smoke, exercise, stress, exposure to cold air