Rheumatic heart disease in pregnancy
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are common and under-diagnosed in remote Australia
- If planning pregnancy — see pre-pregnancy counselling
Do
- Ask about ARF/RDH
- Check file notes and contact Rheumatic Heart Disease Register for more information
- Medical consult as soon as possible for pregnant woman with RHD or suspected RHD
- Arrange early obstetric ultrasound, ECG, ECHO and dental check
- Urgent referral to obstetrician and physician/cardiologist as soon as possible
Talk with woman about
- Looking after herself and continuing her medicine
- More frequent antenatal checks and hospital visits to watch for problems
- Seeing midwife or doctor any time she is concerned
- Support services that can help her and assist with moving closer to hospital for birth
Antenatal care
- At each visit ask about — physical activity, sleeping, any need to sleep sitting up, tiredness, light-headedness, dyspnoea (shortness of breath)
- If signs or symptoms of heart failure or problem that could cause heart failure (eg anaemia, infection, high BP) — urgent medical consult straight away
- Follow joint management plan from physician/cardiologist and obstetrician
- Continue routine antibiotic prophylaxis during pregnancy
- Any woman on warfarin needs urgent medical consult
- Anticoagulation therapy usually needs to be changed — usually to heparin (eg enoxaparin) given by daily injections
- Always plan for birth in hospital — delivery in hospital ICU may be required
Prevention of endocarditis
- See Acute rheumatic fever and rheumatic heart disease
- Highest risk of endocarditis (infection inside heart) in women with
- Rheumatic heart disease
- Artificial heart valve
- Heart transplant
- History of bacterial endocarditis
- Certain congenital heart problems
- May need preventive antibiotics before invasive, surgical or dental procedures
- Always do medical/dental consult
Unplanned labour or birth in community
- Put in IV cannula — largest possible, insert 2 if time
- Medical consult before giving IV fluids — too much can cause heart failure
- Record frequent observations and fluid balance during labour and after birth
- Monitor closely. If woman becomes short of breath
- Sit upright
- Give oxygen to target O2 sats 94–98% OR if moderate/severe COPD 88–92%
- Urgent medical consult
- See Labour and birth
- Do not give ergometrine alone or in combination after birth — after delivery only use plain oxytocin IM — 10 international units single dose — placenta should separate within a few minutes
- RHD Australia ARF/RHD guidelines