Complications in polyhydramnios Maternal complications: • PIH. • Malpresentation • PROM, Preterm delivery • Abruptio placentae • Cord Prolapse • PPH due to uterine atony • Increase operative interference • Subinvolution Fetal complications: • ↑Perinatal mortality
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Clark’s Classification of Heart disease in pregnancy Group 1= ASD, VSD, PDA (congenital heart diseases), Any disease involving pulmonary and tricuspid valve & Bioprosthetic valve replacement. Maternal mortality <1% Group 2= Maternal mortality 15-25 % Group 3= Maternal mortality 25-50 % → Pulmonary hypertension -primary or secondary, an example of secondary being -Eisenmenger syndrome →
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Anticoagulant of choice in pregnancy During pregnancy, the choice of anticoagulant depends on period of gestation. Warfarin Heparin Advantage Strong anticoagulant Cannot cross the placenta Disadvantage Can cross the placenta and lead to Chondrodysplasia in fetus Weak anticoagulant Period of Gestation Anticoagulant of choice ≤ 12 weeks Heparin 12 – 36 weeks Warfarin
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Heading-Antenatal Visits Ideally: Till 28 weeks-once/month 28-36 weeks-twice/month 36 weeks-Every week WHO – 4 Visits Government of India- 3 Visits: 20 weeks-1st visit 32 weeks-2nd visit 36 weeks-3rd visit
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Diagnosis of gestational diabetes The diagnosis of gestational diabetes is done by: 2 step approach-By ACOG-American College of Obstetricians and Gynecologists 1 step approach-By WHO & IAD PSG (International association of Diabetes & Pregnancy Study Group)-Recommended by DIPSI (Diabetes in pregnancy study group India).
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Criteria for diagnosing gestational diabetes Carpenter and Coustan Criteria National Diabetes data group Time 100 g Glucose Load 100 g Glucose Load Fasting 95 mg/dl 105 mg/dl 1 hour 180 mg/dl 190 mg/dl 2 hours 155 mg/dl 165 mg/dl 3 hours 140 mg/dl 145 mg/dl → If out of these any 2 values are
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2 step approach-ACOG 1st step is screening = GCT (Glucose Challenge Test) → Time= 24-28 weeks → No fasting required → Method: Give 50gm of glucose to patients → Check blood glucose levels <140mg/dl-Nothing >140 but <180mg/dl-Perform- NEXT STEP ≥180mg/dl-Confirm Diabetes → ACOG recommends universal screening in all pregnant females irrespective of risk factors →
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1 step approach-WHO & IAD PSG → It is done only in females with any risk factor @ 24-28 weeks of pregnancy. → It is used both for screening and diagnostic purpose. → Patient is advised unrestricted diet for 72 hours followed by overnight fasting and then 75 gm of glucose is given. →
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Anesthesia used in caesarean → Anesthesia given during LSCS in heart disease: Epidural anesthesia. → Conditions where general anesthesia is given in cesarean (to prevent hypotension) Intracardiac shunts Severe aortic stenosis Pulmonary arterial hypertension 4.Severe Aortic Regurgitation 5.HOCM-Hypertrophic obstructive cardiomyopathy
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Indicators of heart disease during pregnancy Indicators of heart disease during pregnancy include the following: Clubbing Cyanosis Paroxysmal nocturnal Dyspnea Orthopnea Pulmonary Edema ↑ JVP S2 Loud prominent Split Getting S4 is abnormal Ejection Systolic Murmur >3/6 Diastolic Murmur Marked Cardiomegaly Any Arrhythmia
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