Cardiac disease in pregnancy and drug therapy: Difference between revisions
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*[[Atenolol]] | *[[Atenolol]] | ||
*[[Carvedilol]] | *[[Carvedilol]] | ||
* | *The efficacy and safety of [[thrombolytics]] is mostly untested: | ||
:*Greatest experience in massive [[pulmonary embolism]] | :*Greatest experience in massive [[pulmonary embolism]] | ||
:*[[Streptokinase]] does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid | :*[[Streptokinase]] does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid |
Revision as of 01:07, 11 October 2012
Cardiac disease in pregnancy Microchapters |
Diagnosis |
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Catheterization: |
Treatment |
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Cardiac disease in pregnancy and drug therapy On the Web |
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Directions to Hospitals Treating Cardiac disease in pregnancy |
Risk calculators and risk factors for Cardiac disease in pregnancy and drug therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
ACE inhibtors, Angiotensin receptor blockers (ARBss), and warfarin should be avoided in pregnancy.
Contraindicated Drugs
- ACE inhibitors can cause morbidity in 30% of fetuses after 14 weeks due to renal tubular dysplasia, neonatal renal failure, oligohydroamnios, reduced cranial oosification and intrauterine growth retardation (IUGR)
- Angiotensin receptor blockers (ARBss). These agents are safe during lactation though.
- Aldosterone antagonists cause antiandrogenic effects in the first trimester and should be avoided.
- Warfarin is teratogenic
Drugs to be Avoided
- Atenolol
- Carvedilol
- The efficacy and safety of thrombolytics is mostly untested:
- Greatest experience in massive pulmonary embolism
- Streptokinase does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid
- Urokinase not teratogenic in mice/rats
- Risk for maternal hemorrhage (1 case of placental abruption reported); increased risk when given at time of delivery
- Delivery best delayed at least 2-3 weeks
Acceptable Drugs
- ASA - low dose
- Beta-1 selective Beta-blockers like lopressor, metoprolol.
- Digoxin affects the fetus as well
- Diuretics can reduce placental perfusion and should be used sparingly
- Hydralazine
- Magnesium
- Morphine sulfate
- Nitrates – use low dose to prevent fetal distress