妊娠合并内科疾病（英文）妇科八年制教学课件.ppt

MEDICAL COMPLICATIONS IN PREGNANCY妊娠合并内科疾病 陈晓军 复旦大学附属妇产科医院 Heart Disease in Pregnancy 妊娠合并心脏病 I want a baby… 27 years old Atrial septal defect 1cm Feel discomfort only after ordinary activity Can I have a baby? What is the risk for me and my baby? What should I do during the course of pregnancy? By which way should I delivery my baby? Any special thing to be paid attention to after birth? Heart Disease Incidence:1-4% of pregnancies One of the leading causes of maternal death (8.3%) Death rate 0.6%-2.7% Classification of Heart Disease Congenital heart disease （先天性心脏病） Left-to right shunt Right-to left shunt Non-shunt Rheumatic heart disease （风湿性心脏病） Hypertensive heart disease（妊娠期高血压疾病性心脏病） Peripartum cardiomyopathy (PPCM) Myocarditis （心肌炎） Peripartum cardiomyopathy (PPCM) 围产期心肌病 Dilated cardiomyopathy occurs during the last 3 months of pregnancy to 6 months postpartum (increased heart size, decreased heart function) Etiology unknown No history of cardiovascular disease Die from heart failure, arrhythmia or pulmonary infarction 50% recover 6 months postpartum Recur in the successive pregnancy Clinical Implications ：10-30% of fetal death Therapy Treatment for heart failure Heart transplantation Cardiac Function Subjective capacity Class I: Uncompromised Class II: Slightly compromised Class III: Marked compromised Class IV: Severely compromised Objective examination A: Without objective basis of cardiac disease B: Mild cardiac disease according to objective exam C: Moderate … D: Severe … Management TO BE OR NOT TO BE Preconceptional counseling Pregnancy YES or NO ? Preconceptional counseling During Pregnancy Determine whether or not the pregnancy should be continued NO: induced abortion before 12 weeks YES: Intensive care during pregnancy Early diagnosis and treatment of congestive heart failure Intensive care during pregnancy Detect congestive heart failure as early as possible before 20 weeks: 1 time per 2 weeks after 20 week