Beruflich Dokumente
Kultur Dokumente
MDICAS EN EL
EMBARAZO
Vctor Gabriel Arteaga Huanca
CARDIOVASCULARES
The maternal mortality ratio in low- to middle-income countries (LMIC) is 14 times higher than in high-income countries (HIC).
While direct causes of maternal death such as complications of hypertension, obstetric haemorrhage and sepsis remain the
largest cause of maternal death in LMICs, cardiovascular disease emerges as an important contributor to maternal mortality in
both developing countries and the developed world, hampering the achievement of the millennium development goal 5, which
aimed at reducing by three-quarters the maternal mortality ratio until the end of 2015.
Medical disease as a cause of maternal mortality: the pre-imminence of cardiovascular pathology. AO Mocumbi, K Sliwa, P
Soma-Pillay. 2016
Cambios hemodinmicos
Parmetro
Cambio (%)
Gasto cardiaco
+17
Frecuencia cardiaca
+17
+17
-21
-34
+4
Presin coloidosmtica
-14
Thrombosis in Pregnancy and Maternal Outcomes Andra H. James. BIRTH DEFECTS RESEARCH (PART C) 105:159166
(2015)
Datos clnicos
Cianosis
Puntilleo o punzadas en los dedos
Distensin persistente de las venas del cuello
Soplo sistlico grado 3/6 o mayor
Soplo diastlico
Cardiomegalia
Arritmia persistente
Desdoblamiento persistente del segundo ruido
Criterios para hipertensin pulmonar
Riesgos
estimados:
contraindicaciones
de embarazo
Diagnstico cardiovascular
1) History and clinical investigation
Many disorders can be identified by taking a careful personal and family history,
particularly cardiomyopathies, the Marfan syndrome, congenital heart disease,
juvenile sudden death, long QT syndrome, and catecholaminergic ventricular
tachycardia (VT) or Brugada syndrome. It is important to ask specifically about
possible sudden deaths in the family.
2) dyspnoea
The assessment of dyspnoea is important for diagnosis and prognosis of valve
lesions and for heart failure. A thorough physical examination considering the
physiological changes that occur during pregnancy is mandatory, including
auscultation for new murmurs, changes in murmurs, and looking for signs of
heart failure. When dyspnoea occurs during pregnancy or when a new
pathological murmer is heard, echocardiography is indicated. It is crucial to
measure the BP, in left lateral recumbency using a standardized method, and to
look for proteinuria, especially with a history or family history of hypertension or
pre-eclampsia. Oximetry should be performed in patients with congenital heart
disease.
3) Electrocardiography
The great majority of pregnant patients have a normal electrocardiogram (ECG).
The heart is rotated towards the left and on the surface ECG there is a 1520 left
axis deviation. Common findings include transient ST segment and T wave
changes, the presence of a Q wave and inverted T waves in lead III, an attenuated
Q wave in lead AVF, and inverted T waves in leads V1, V2, and, occasionally, V3.
ECG changes can be related to a gradual change in the position of the
heart and may mimic left ventricular (LV) hypertrophy and other structural
heart diseases. Holter monitoring should be performed in patients with known
previous paroxysmal or persistent documented arrhythmia [VT, atrial fibrillation
(AF), or atrial flutter] or those reporting symptoms of palpitations.
4) Echocardiography
Because echocardiography does not involve exposure to radiation, is easy to
perform, and can be repeated as often as needed, it has become an important tool
during pregnancy and is the preferred screening method to assess cardiac
function.
5) Transoesophageal echocardiography
Multiplane transducers have made transoesophageal echocardiography a very useful
echocardiographic method in the assessment of adults with, for example, complex
congenital heart disease. Transoesophageal echocardiography, although rarely
required, is relatively safe during pregnancy. The presence of stomach contents,
risk of vomiting and aspiration, and sudden increases in intra-abdominal pressure
should be taken into account, and fetal monitoring performed if sedation is used.
6) Exercise testing
Exercise testing is useful to assess objectively the functional capacity, chronotropic and BP
response, as well as exercise-induced arrhythmias. It has become an integral part of the
follow-up of grown up congenital heart disease patients as well as patients with
asymptomatic valvular heart disease.
7) Radiation exposure
The effects of radiation on the fetus depend on the radiation dose and the gestational age
at which exposure occurs.
If possible, procedures should be delayed until at least the completion of the period
of major organogenesis (>12 weeks after menses).
There is no evidence of an increased fetal risk of congenital malformations, intellectual
disability, growth restriction, or pregnancy loss at doses of radiation to the pregnant
woman of <50 mGy
Hipertensin en embarazo
Preeclampsia-Eclampsia
Hipertensin crnica
Hipertensin crnica con preeclampsia sobrepuesta
Hipertensin gestacional
Hipertensin post parto
HEMATOLGICAS
Anemia :
En el embarazo se define como un hematocrito inferior al 30% o una hemoglobina
inferior a 10g/dl.
Las consecuencias directas de la anemia en el feto son mnimas.
Si la anemia se repara la mujer tendr una mejor capacidad de respuesta frente a la
hemorragia aguda perinatal.
La anemia ferropnica es la ms frecuente (90%). La National Academy of sciences
recomienda 27 mg de aporte complementario de hierro al da. Tratamiento 120 mg
hierro al da. Aporte de vitamina C entre comidas.
Cncer y embarazo
The diagnosis of cancer is established in about 0.1 % of pregnancies, making it
the second most common cause of maternal death after gestation-related vascular
complications.
Breast cancer-Cervical cancer-Thyroid cancer-Hodgkin lymphoma
Breast cancer occurs about once in every 3,000 pregnancies. It occurs most often
between the ages of 32 and 38.
Lymphoma is the fourth most common malignancy diagnosed in pregnancy; Hodgkin
lymphoma is more frequent in pregnant women than non-Hodgkin lymphoma (NHL). The
proportion of highly aggressive lymphomas in pregnant women is significantly higher
than in non-pregnant women of reproductive age
Cancer in pregnancy creates procoagulant environment which can lead to maternal
VTE and placental occlusion, frequently manifested by preeclampsia, fetal growth
restriction or loss, and placental abruption.
Haematological malignancies in pregnancy: An overview with an emphasis on thrombotic risks. Thrombosis and
Haemostasis. 2016
Thrombophilia
Complications
and
Pregnancy
PSQUIATRICAS
Guidelines for the Management of Pregnant Women with Substance use Disorders. Psychosomatics . 2016