Article on Heart Disease and Pregnancy, Gestational Diabetes

Article on Heart Disease and Pregnancy, Gestational Diabetes

This article presents some basic knowledge about heart disease and gestational diabetes, compiled from multiple-choice questions and answers.

1. Heart Disease and Pregnancy

• The mother’s blood volume increases to its maximum in the 7th month of pregnancy.

• Pregnant women with a history of heart disease, experiencing shortness of breath when climbing one flight of stairs, are classified as having Class II heart failure.

• Lung ventilation increases, and maternal blood pCO2 decreases in the last trimester of pregnancy when the pregnant woman has heart disease.

• The cardiovascular system and heart in pregnant women with heart disease have a 40% increase in circulatory volume, mainly due to an increase in plasma.

• During placental delivery, people with heart disease are often at risk of acute pulmonary edema.

• Class III heart failure is diagnosed based on shortness of breath, rapid pulse, enlarged liver, enlarged heart size on X-ray, and cyanosis.

• The frequency of heart disease in pregnancy is 1-2%.

• Complications of heart disease with pregnancy include: acute heart failure, premature labor, preterm birth, embolism, arrhythmias.

• Cardiomyopathy is not part of the congenital heart disease group.

• In postpartum women with heart disease, the incidence of thromboembolism is unknown.

• When managing heart disease and pregnancy medically, it is necessary to guide the patient on rest and proper nutrition, advise on potential complications, and administer medications for heart support, sedation, anticoagulation, and infection prevention. Do not use uterine relaxants.

• For pregnant women without heart failure, pregnancy can be maintained if there is close monitoring and care, cardiac intervention when indicated, and assisted delivery when conditions allow. Do not terminate the pregnancy immediately in the first trimester.

• For pregnant women with Class III and IV heart failure, pregnancy should be terminated regardless of gestational age. Choose an appropriate termination method according to gestational age, and perform assisted delivery.

• When delivering the placenta, forceps can be used to deliver the baby if conditions allow.

• Pregnant women with heart disease can still breastfeed, but should stop breastfeeding if they experience shortness of breath or chest pain.

• Pregnant women with heart disease should deliver at a specialized hospital.

• Favorable factors for thromboembolism in pregnant women with heart disease include: atrial fibrillation, mitral stenosis, retained placenta, postpartum inactivity. It is not related to uterine inversion.

• Heart disease can cause fetal growth restriction, intrauterine fetal demise, and preterm birth. It cannot cause fetal malformations.

• A rare complication in pregnant women with heart disease is myocardial infarction.

• The most common valvular heart disease in pregnant women is valvular heart disease.

• The principle of managing heart disease and pregnancy is to primarily prevent and treat complications, primarily protecting the mother, and considering the baby, especially the fetus. It is necessary to understand the type of valvular heart disease. It is not necessary to manage pregnancy at the primary level with a small fetus (first trimester) without heart failure.

• Pregnancy care for pregnant women with heart disease includes: relative rest and a relatively low-salt diet in the first trimester, absolute rest and a strictly low-salt diet in the last trimester, and close monitoring and management in terms of obstetrics and gynecology throughout pregnancy. It is not necessary to go to the hospital for monitoring at the 34th week of pregnancy.

• Management of pregnant women with heart disease during labor includes: mandatory treatment: heart support, blood pressure control if indicated, uterine control if indicated, after delivery of the placenta, push the abdomen while simultaneously lowering both legs immediately after delivery. Do not use forceps if there is heart failure.

• In managing postpartum women with heart disease, it is necessary to closely monitor the heart, blood pressure, and blood pressure in the first few days after delivery. Engage in early activity if the heart condition allows to prevent venous thrombosis, use antibiotics prophylactically for 10 days to prevent infection and Osler. Absolutely do not breastfeed in all cases.

• Pregnant women with cyanotic congenital heart disease are more likely to have a malformed fetus.

• During pregnancy, heart disease can cause more preterm births than miscarriages.

• The most common complication in cardiovascular disease in pregnancy is heart failure.

• The highest risk of thromboembolic events due to cardiovascular disease in pregnancy is during labor and immediately after delivery.

• Heart failure due to pregnancy is less likely to occur in the first trimester of pregnancy.

• Necessary measures for managing a pregnant woman with heart disease during labor include: administering oxygen to the mother, increasing contractions systematically. It is not necessary to perform spinal anesthesia or perform a cesarean section immediately.

• Management protocol for pregnant women with heart disease: Fetuses without heart failure: maintain pregnancy, hospitalize for monitoring 1 month before delivery; Fetuses with heart failure: terminate pregnancy at any gestational age, if over 6 months, monitor, hospitalize 1 month before delivery; Fetuses without heart failure: terminate pregnancy at any gestational age, if over 6 months, monitor, hospitalize 1 month before delivery; Fetuses with heart failure: terminate pregnancy at any gestational age.

• 4 methods of prevention and primary health care for pregnant women with heart disease: Promote awareness of cardiovascular disease in pregnancy, register for pregnancy management, provide care, provide regular checkups for pregnant women with cardiovascular disease in pregnancy, and use contraception for women with heart disease.

2. Gestational Diabetes

• The WHO oral glucose tolerance test is: fasting for a maximum of 8 hours, drinking 75 grams of glucose, taking 4 blood samples, 2 hours after drinking 75 grams of glucose, blood glucose of 8.6 mmol/L is a definitive diagnosis of diabetes.

• It is necessary to screen for diabetes in high-risk pregnant women during the initial prenatal visit.

• Cases requiring glucose tolerance testing include polyhydramnios, twin pregnancy, and babies larger than gestational age.

• In the first trimester of pregnancy, gestational diabetes can cause fetal malformations, miscarriage, and stillbirth. It cannot cause macrosomia.

• In the second trimester of pregnancy, gestational diabetes can affect fetal brain development, polyhydramnios, and stillbirth. It cannot cause fetal malformations.

• In terms of managing gestational diabetes, the general principle is to adjust the diet so that fasting blood glucose is less than 5.3 mmol/L and 2 hours after meals is less than 7.0 mmol/L. If blood glucose is not stable, oral hypoglycemic agents should be used, and blood glucose should be monitored multiple times a week. The fetal lungs mature later than those of normal fetuses of the same gestational age. A 75 mg – 2 hour glucose tolerance test should be performed at the 6th week postpartum.

• The statement that is not true about gestational diabetes is that the major impact of the disease is the death of 2/3 of newborns during pregnancy.

• During pregnancy, gestational diabetes can lead to many complications including: spontaneous miscarriage, stillbirth in the first trimester of pregnancy, fetal malformations, and macrosomia.

• Neonatal hypoglycemia is most pronounced in the second hour after delivery.

• A woman with type I diabetes can use any of the above contraceptive methods.

• In the late stages of pregnancy, there is an increase in hormones that stimulate glucagon secretion, increase glycogenolysis to glucose in the liver, decrease glucose uptake in peripheral tissues, and a decrease in maternal insulin secretion.

• The impact of diabetes on pregnancy includes: maternal nephritis, pyelonephritis, postpartum hemorrhage, higher cesarean section rates, and newborns are prone to hypoglycemia.

• The most appropriate contraceptive method for women with gestational diabetes who have completed their family is sterilization.

• In managing uncomplicated gestational diabetes, when the pregnancy is full-term, the mother can be observed for spontaneous labor. Elective cesarean section is not recommended at 38 weeks, 39 weeks, and is contraindicated for labor induction.

Note: This article only provides general information about heart disease and gestational diabetes. For specific cases, please consult a specialist for appropriate advice and treatment.