References:
- Dr. RPS Maternal and Newborn Care: A Comprehensive Guide and Source Book for Teaching and Learning, 2nd Edition, ISBN 978-971-98-2265-3, by Rosalinda Parado Salustiano (pp. 117-195)
- Lecturer (V)
Also known as gravidocardiac patients, these are pregnant women who experience heart disease during pregnancy. The most common predisposing factor is rheumatic heart disease caused by rheumatic fever secondary to respiratory infection by Group A Beta-Hemolytic Streptococcus.
- The affected side of the heart is the left side, as oxygenated blood from pulmonary circulation returns to the left atrium, resulting in carditis. Adherence of some microorganisms to the mitral valve results in inflammation of the mitral valve, swelling occurs, resulting in mitral valve prolapse.
- The antibiotic drug of choice for GABHS is Penicillin. Late administration still cures the infection, but scarring may occur on the mitral valve. Hardening of the mitral valve leads to inability to close, resulting in continuous blood flow. This permanent damage, mitral valve stenosis, leads to gravid cardiac patients.
- GABHS may also result from dental caries, which contain Staphylococcus aureus and Streptococcus. It may be transferred from men to women through oral contact as well. Oral care should be marked as important.
Blood volume increases by 30 to 50% in pregnancy. Due to the damage to the mitral valve, hypertrophy of the heart occurs, leading to weakening of the left ventricle (decreased pumping ability), resulting in left-sided congestive heart failure with pulmonary congestion (edema). Cardiac arrest may occur, resulting in death.
| Type | S/S | Damage | Activity Level | Activity Limitation | Delivery |
|---|---|---|---|---|---|
| I | (–) | Very minimal | None | None | NSD |
| II | (+) | Minimal | Heavy | Slight Limitation | NSD/Forcep |
| III | (+) | Moderate | Light | Marked Limitation | Forcep/Abortion |
| IV | (+) | Severe | At rest | Complete Bed Rest | Forcep/Abortion |
Signs and symptoms include difficulty of breathing, palpitations, easy fatiguability, chest pain, etc.
- “Activity Level” denotes the level of activity required to produce the signs and symptoms.
- S/S refers to the presence of symptoms, i.e., only Type I gravidocardiac patients are asymptomatic.
Forcep Delivery
Forcep deliveries are guided deliveries that are done with epidural anesthesia, with a ruptured bag of water, fully dilated cervix, and a fully effaced cervix, as the baby descends with positive station. There are two types:
- Mid Forcep Delivery: +1 - +2
- Low Forcep Delivery: +3 - +4
Also read: 217a-rheumatic-fever