【精品】2012年南京市市政基础设施工程安全生 .54教程文件.pptVIP

Medical and Surgical Complications during Pregnancy;Incidence Heart disease complicates about 1 percent of pregnancies. Component congenital heart disease rheumatic heart disease hypertensive heart disease other varieties (inclued: pregnancy-induced hypertension, thyroid, coronary, syphilitic, and kyphoscoliotic cardiac disease) idiopathic cardiomyopathy (perinatal cardiomyopathy) isolated myocarditis various forms of heart block ; 0.3 per 10,000 live births Heart disease still significantly contributes to maternal mortality. 5.6-8.5 percent of maternal deaths ;Effect of pregnancy on heart disease ;Clinical Classification (By the New York Heart Association) ;Class III Markedly compromised: Patients with cardiac disease and marked limitation of physical activity. They are comfortable at rest, but less than ordinary physical activity causes discomfort by excessive fatigue, palpitation, dyspnea, or anginal pain. Class IV Severely compromised: Patients with cardiac disease and inability to perform any physical activity without discomfort. Symptoms of cardiac insufficiency or angina may development at rest, and if any physical activity is undertaken, discomfort is increased.;Diagnosis of heart disease ; Severe or progressive dyspnea Progressive orthopnea Paroxysmal nocturnal dyspnea Hemoptysis Syncope with exertion Chast pain related to effort or emotion Clinical Findings Cyanosis Clubing of fingers; Persistent neck vein distension Systolic murmur greater than grade 3/6 Diastolic murmur Cardiomegaly Sustained arrhythmia Persistent split second sound Criteria for pulmonary hypertension Left parasternal lift Loud P2;Conventional tests Electrocardiography Ecocardiography Chast X-ray Diagnosis of early heart failure during pregnancy Dyspnea, palpitation at slight physical activity. Resting pulse larger than 110 beats per minute. Paroxysmal nocturnal dyspnea. Rale i