High-Risk Antepartum Nursing

 Chapter 7 High-Risk Antepartum Nursing
 Pre-gestational Complications
 For some women, pregnancy represents significant risk because it is superimposed on preexisting illness
 Cardiovascular Disorders
Classifications
Risks for woman
Risks for newborn
Assessment findings
Management
Nursing actions
 Cardiovascular Disorders
 Congenital heart disease is becoming more common as more women are surviving into their reproductive years.
 Stuff you already know:
 Normal heart compensates for increased workload
 Major cardiovascular changes during pregnancy are:
 Increased intravascular volume – 1500 cc’s
 Decreased systemic vascular resistance d/t peripheral vasodilation
 Cardiac output changes during labor and birth –
 During each contraction, an average of 400 ml of blood is emptied from the uterus into the maternal vascular system
 increases cardiac output by about 12% to 31% in the first stage and
 by about 50% in the second stage
 Intravascular volume changes that occur just after childbirth
 Diseased heart is hemodynamically challenged
 Cardiac conditions account for 10-25% maternal mortality
 Pulmonary HTN - Maternal mortality rate of more than 50% during pregnancy associated with pulmonary hypertension
 Endocarditis
 CAD
 Cardiomyopathy
 Sudden arrhythmias
 Maternal and neonatal outcomes based on classification (severity) of maternal heart disease –
 Degree of disability often more important in treatment and prognosis
 Greatest risk for women who have had at least one of the following:
 A prior cardiac even or arrhythmia
 Think of my patient with Lupus and hx of MI who ended up dying two weeks postpartum
 NY Heart Assn functional Class II or greater
 Cyanosis
 Left heart obstruction
 Systematic ventricular dysfunction
 Estimated risk of cardiac event during pregnancy
 If they have:
 None of the above then risk is 5%
 One of the above then risk is 27%
