1)Primary pulmonary hypertension '(PPH), where the reported maternal mortality is around 50-60 per cent. It is also important to realize that even though pre-conceptional symptolns are mild, progression is rapid during pregnancy. High incidence of prematurity or fehls, fetal growth retardation and fetal loss are associated with PPH.
2) Eisenmenger's syndrome, which is due to developillent of pulmonary hypertension in patients with pre-existing left to right shunt, which becomes either bi-directional or light to left shunt. The maternal mortality in this situation is around 40 per cent. It is associated with poor fetal out comes with fetal loss,prematurity, fetal growth retardation and premature death.
3) Complex congenital heart diseases. Although there are recent reports of successf~il management of pregnancies with repaired or umepaired co~nplex congenital heart diseases, there is increased iisk to the illother as well as to the fetus. Individual patients need to be evaluated and proper advise given.
4)Diseases like Marfan's syndrome particulr~ly when there is significant dilatation of aortic root, pre-conceptional counseling is required and sisk to lnother and fetus assessed and advised.
5 ) Other situations including advanced valvular.heart diseases, advanced heart failure and previous history of peripxtum ca~~diomyopathy.Proper preconceptional counseling is needed and advised against pregnancy.
Termination of Pregnancy
1) General
There ase two main indications for terininntion of pregnancy:Fetal abnormality or life tllreatening maternal illness. Fctal abnormalities include conditions that are incompatible with life such as anencephaly 01. renal agenesis, gross fetal anomalies like chromosomal anomalies, severe congenital abnormalities including cardiac defects or gross physical abnoilalities.
2) Maternal Conditions
a) Complications of pregnaricy:
(i) Severe pre-eclampsia before fetal viability,where progression of the pregnancy to the stage of viability may put the mother at significant ~ i s k (ii)Premature rupture of the ~nenlbranes with infection prior to fetal viability. (iii) Severe ante pastum hemorrhage prior to fetal viability.
'
b) Primary maternal conditions: (i) Cellain maternal conditions may be lethal if pregnancy is permitted to continue, for e.g., Piirnary pulmonary hypertension, Eisenmenger's syndrome, and severe co~lgenital heart diseases.(ii) Where the mother is suffering from end stage malignancy. (iii) Severe psychological illness in the mother.
3) Petal Conditions
There are very sinall nuinbers of fetal conditions where the progression of pregnancy may lead to significant materrnal morbidity or mortality: (i) Hydrops fetalis - immune and non-immu~ie. .(ii) Fetus is present with hydatidiform mole or choriocar~inoma.Before the decision of termination of pregnancy, labor is considered. It needs multi disciplinary approach with consultation with physician, cardiologist, obstetiician,ultrasonologist, geneticist, nursing staff and counselors. However, the final decision concerning termination and the method of termination rests wit11 ihe mother, Finally legal aspects of teiminatio~i has to be considered.
Methods of termination: (i) Induction of labor with prostaglandins, (ii) Dilatation, and evacuation following cervical ripening with prostaglandins.After termination, care of the mother is important and depending on the cardiac condition, she may be treated in intensive cardiac care unit or ward.
2) Eisenmenger's syndrome, which is due to developillent of pulmonary hypertension in patients with pre-existing left to right shunt, which becomes either bi-directional or light to left shunt. The maternal mortality in this situation is around 40 per cent. It is associated with poor fetal out comes with fetal loss,prematurity, fetal growth retardation and premature death.
3) Complex congenital heart diseases. Although there are recent reports of successf~il management of pregnancies with repaired or umepaired co~nplex congenital heart diseases, there is increased iisk to the illother as well as to the fetus. Individual patients need to be evaluated and proper advise given.
4)Diseases like Marfan's syndrome particulr~ly when there is significant dilatation of aortic root, pre-conceptional counseling is required and sisk to lnother and fetus assessed and advised.
5 ) Other situations including advanced valvular.heart diseases, advanced heart failure and previous history of peripxtum ca~~diomyopathy.Proper preconceptional counseling is needed and advised against pregnancy.
Termination of Pregnancy
1) General
There ase two main indications for terininntion of pregnancy:Fetal abnormality or life tllreatening maternal illness. Fctal abnormalities include conditions that are incompatible with life such as anencephaly 01. renal agenesis, gross fetal anomalies like chromosomal anomalies, severe congenital abnormalities including cardiac defects or gross physical abnoilalities.
2) Maternal Conditions
a) Complications of pregnaricy:
(i) Severe pre-eclampsia before fetal viability,where progression of the pregnancy to the stage of viability may put the mother at significant ~ i s k (ii)Premature rupture of the ~nenlbranes with infection prior to fetal viability. (iii) Severe ante pastum hemorrhage prior to fetal viability.
'
b) Primary maternal conditions: (i) Cellain maternal conditions may be lethal if pregnancy is permitted to continue, for e.g., Piirnary pulmonary hypertension, Eisenmenger's syndrome, and severe co~lgenital heart diseases.(ii) Where the mother is suffering from end stage malignancy. (iii) Severe psychological illness in the mother.
3) Petal Conditions
There are very sinall nuinbers of fetal conditions where the progression of pregnancy may lead to significant materrnal morbidity or mortality: (i) Hydrops fetalis - immune and non-immu~ie. .(ii) Fetus is present with hydatidiform mole or choriocar~inoma.Before the decision of termination of pregnancy, labor is considered. It needs multi disciplinary approach with consultation with physician, cardiologist, obstetiician,ultrasonologist, geneticist, nursing staff and counselors. However, the final decision concerning termination and the method of termination rests wit11 ihe mother, Finally legal aspects of teiminatio~i has to be considered.
Methods of termination: (i) Induction of labor with prostaglandins, (ii) Dilatation, and evacuation following cervical ripening with prostaglandins.After termination, care of the mother is important and depending on the cardiac condition, she may be treated in intensive cardiac care unit or ward.
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