Classification of cardiac compensatory function in pregnancy complicated with heart disease. All of us should pay attention to the situation of pregnant mothers during pregnancy, because under normal circumstances, the situation of pregnant mothers has a great influence on the healthy development of babies, and pregnancy complicated with heart disease may occur. The following is the classification of cardiac compensatory function in pregnancy complicated with heart disease.
The cardiac compensatory function of pregnancy complicated with heart disease is 1. Pregnancy, childbirth and puerperium can increase the heart burden of patients with heart disease and induce heart failure, which is one of the important causes of maternal death. The incidence of pregnancy complicated with heart disease is 1-4%.
1, type
Rheumatic heart disease, congenital heart disease, hypertensive heart disease in pregnancy, perinatal cardiomyopathy, arrhythmia, anemia heart disease, hypertensive heart disease, hyperthyroidism heart disease, etc.
2. The effects of pregnancy and childbirth on heart disease.
(1) Pregnancy:
Blood volume increased by about 35%, reaching the peak at 32 ~ 34 weeks of pregnancy. The increase of cardiac output in early pregnancy is 30%-50% higher than that before pregnancy, and the cardiac output is greatly affected by the posture of pregnant women, and some pregnant women have "supine hypotension syndrome". The uterus enlarges and the diaphragm rises, which makes the heart move 2. 5-3. 0 cm to the upper left, and the great vessels are twisted. The increase of cardiac output and the acceleration of heart rate lead to mild hypertrophy of myocardium, which is easy to cause heart failure in pregnant women with heart disease.
(2) Delivery date:
The period with the heaviest burden on the heart
The first stage of labor: every time the contraction (250-500ml) increases, the cardiac output increases by 20%.
The second stage of labor: besides uterine contraction, the burden of the parturient is the heaviest → increased pressure of pulmonary circulation → visceral blood → heart.
The third stage of labor: after the delivery of fetal placenta → 500ml systemic circulation of uterine blood sinus blood → sharp increase of blood volume. The uterus contracts rapidly, the abdominal pressure plummets → splanchnic blood vessels dilate → a large amount of blood flows to internal organs, and the amount of returned blood decreases → heart failure occurs.
(3) Puerperal period: The blood volume increases again on the 3rd postpartum day: uterine contraction, interstitial fluid → systemic circulation → heart failure.
3. The most dangerous period for pregnant women with heart disease: 32-34 weeks of pregnancy, delivery and the first 3 days of puerperium.
4. Classification of compensatory function of heart disease
Divided into four levels:
(1) Grade I: general physical activity is unrestricted (asymptomatic).
(2) Grade II: general physical activity is slightly limited (palpitation, mild shortness of breath), and there are no symptoms at rest.
(3) Grade III: general physical activity is obviously limited (mild daily work means discomfort, palpitation and dyspnea), and there is no discomfort after rest; Or have a history of heart failure in the past.
(4) Grade IV: unable to carry out any activities, still having heart failure symptoms such as palpitation and dyspnea at rest.
5. Diagnosis of heart failure in early pregnancy
Diagnosis of clinical manifestations of early heart failure;
Chest tightness, palpitation and shortness of breath appear after slight activity.
At rest, the heart rate exceeds 1 10 times per minute, and breathing exceeds 20 times per minute.
Sit up and breathe at night, or you need to go to the window to breathe fresh air.
A small amount of persistent moist rales appeared at the bottom of the lung, which did not disappear after coughing.
6. Basis of whether a heart disease can be pregnant: We can analyze and estimate whether a heart patient can be pregnant under the burden of delivery and puerperium from the types of heart disease, the degree of pathological changes, the level of cardiac function, specific medical conditions and other factors, and judge whether a heart patient can be pregnant.
First, congenital heart disease
Atrial septal defect; <1cm2 can be used for pregnancy and delivery, > 〉2cm2 pre-pregnancy surgical correction.
Ventricular septal defect: