Cardiac disease in pregnancy and drug therapy: Difference between revisions
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* Beta-1 selective [[Beta-blockers]] like lopressor, metoprolol. | * Beta-1 selective [[Beta-blockers]] like lopressor, metoprolol. | ||
*[[Calcium channel blockers]] are often administered during the second and third trimesters of pregnancy to manage blood presure. However, during the first trimester during organogenesis, there may be a risk for teratogenicity based upon frog embryo studies, and CCBs are classified as [[pregnancy category]] C. | *[[Calcium channel blockers]] are often administered during the second and third trimesters of pregnancy to manage blood presure. However, during the first trimester during organogenesis, there may be a risk for teratogenicity based upon frog embryo studies, and CCBs are classified as [[pregnancy category]] C. | ||
* [[Digoxin]] affects the fetus as well | * [[Digoxin]] is a [[pregnancy category]] C drug and affects the fetus as well. Digoxin is not teratogenic and during the first half of pregnancy, the fetal heart has a reduced ability to bind digoxin. However, during the second half of human gestation, the fetal heart avidly binds and concentrates digoxin. Toxicity in the fetus and neonate is not observed until the serum level reaches 2 to 4 ng/mL, which is greater than adults where toxicity occurs at less than 2 ng/mL. The maternal dig levels should be monitored as the maternal clearance of digoxin is significantly increased. | ||
* [[Diuretics]] can reduce placental perfusion and should be used sparingly | * [[Diuretics]] can reduce placental perfusion and should be used sparingly | ||
* [[Hydralazine]] | * [[Hydralazine]] |
Revision as of 01:25, 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 |
American Roentgen Ray Society Images of Cardiac disease in pregnancy and drug therapy |
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 inhibitors, Angiotensin receptor blockers (ARBss), aldosterone antagonists 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 doses should be used. Complications include an increased risk of placental abruption. ASA is used in pregnant women with antiphospholipid syndrome and preeclampsia.
- Beta-1 selective Beta-blockers like lopressor, metoprolol.
- Calcium channel blockers are often administered during the second and third trimesters of pregnancy to manage blood presure. However, during the first trimester during organogenesis, there may be a risk for teratogenicity based upon frog embryo studies, and CCBs are classified as pregnancy category C.
- Digoxin is a pregnancy category C drug and affects the fetus as well. Digoxin is not teratogenic and during the first half of pregnancy, the fetal heart has a reduced ability to bind digoxin. However, during the second half of human gestation, the fetal heart avidly binds and concentrates digoxin. Toxicity in the fetus and neonate is not observed until the serum level reaches 2 to 4 ng/mL, which is greater than adults where toxicity occurs at less than 2 ng/mL. The maternal dig levels should be monitored as the maternal clearance of digoxin is significantly increased.
- Diuretics can reduce placental perfusion and should be used sparingly
- Hydralazine
- Magnesium
- Morphine sulfate
- Nitrates – use low dose to prevent fetal distress