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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.
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PMID:[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. 45 11

The evaluation of hormonal adaptation of the fetoplacental unit (FPU) in pregnant women with somatic and obstetric complications has demonstrated 4 patterns of adaptation: normal, stressful, maladaptive and unstable. The distribution of FPU adaptive responses across diagnostic groups correlated with types of diseases and their duration in pregnant women. Controlled heart diseases, chronic pyelonephritis without exacerbations, mild toxemia were mostly associated with a normal FPU adaptation. Decompensated heart disease, acute episodes of chronic pyelonephritis, deteriorating toxemia, decompensated diabetes mellitus produced functional activation of FPU hormones. Pregnant women with stable hypertension in the presence of moderately severe toxemia and essential hypertension showed hormonal FPU maladaptation. Differential evaluation of FPU adaptation in pregnant women with somatic and obstetric diseases provides a guide to a range and sequence of interventions for fetal disorders.
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PMID:[Hormonal diagnosis of fetal adaptation disorders in pregnant women with extragenital and obstetric pathology and the principles of their correction]. 208 91

When cardiovascular disease in women is considered, the cardiovascular physiology and diseases related to pregnancy are clearly unique, particularly to young women. Toxemia and its associated hypertension are the major cardiovascular disorders arising during and secondary to pregnancy and may well increase in prevalence as women undertake childbearing at older ages. Although its pathophysiology is unknown and its outcome may be grave to both mother and child, toxemia is preventable, treatable, and curable. This is unlike the three other forms of heart disease occurring in pregnancy discussed here. Aortic dissection, pulmonary hypertension, and peripartum cardiomyopathy are not preventable and are unpredictable, difficult to treat, and incurable. These latter disorders carry on indefinitely for the duration of the patient's life and seriously limit future options, including those for more pregnancies. Among the disorders of the heart in pregnancy, toxemia and peripartum cardiomyopathy are the subjects of especially active investigation at present. Major advances in understanding these disorders could minimize cardiovascular risk to the pregnant woman.
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PMID:Heart disease arising during or secondary to pregnancy. 264 40

Peripartum heart disease is reviewed in the light of reports in the literature and personal experience from the University College Hospital, Ibadan. It is concluded that it is worldwide in distribution but appears most commonly in multiparous black women with a low socioeconomic background. The clinical features are the same as those of dilated cardiomyopathy, with the exception of cases from Zaria, northern Nigeria, where heart failure may be induced by high salt and fluid intake. The possible causes of peripartum heart disease are reviewed. Glomerulonephritis, toxemia of pregnancy, and malnutrition have not been shown convincingly to be causal, and infection, hypertension, and alcoholism have been suggested. Hypertensive heart failure and toxemia of pregnancy can induce peripartum heart disease. It is concluded that the myocardial disorder in peripartum heart disease is probably the same condition as dilated cardiomyopathy, and that infection may be an important element. However, diverse other factors may also play a part.
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PMID:Peripartum heart disease. 384 85

Maternal deaths were reviewed at the American University of Beirut Medical Center during an 11 year period, 1971-82. There were 35,058 livebirths and 45 deaths, making a maternal mortality rate of 128/100,000 livebirths. Hemorrhage, sepsis, and toxemia were the main direct causes of obstetric death. The most important indirect causes were cerebrovascular accidents and heart disease. In this, review, an analytic discussion of the direct and indirect causes of maternal death in Lebanon are presented and preventive measures are discussed.
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PMID:Maternal mortality in the American University of Beirut Medical Center (AUBMC) 1971-1982. 615 95

This review describes the changes in the causes of maternal deaths in a major referral hospital over a span of 55 years. There has been a significant decline in direct maternal deaths from infection, hemorrhage, and toxemia. Continued vigilance is needed since 58% of direct obstetric deaths in our hospital during the last 30 years were considered to have been preventable. Heart disease and nonobstetric infection as indirect causes of maternal deaths have decreased also. Greater effort is necessary to identify those patients with conditions that predispose to indirect deaths and to provide appropriate contraception, sterilization, early pregnancy termination, or optimal multidisciplinary care in a referral hospital.
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PMID:Maternal mortality in a major referral hospital, 1926 to 1980. 708 49

Mitral valve prolapse (MVP) is the most common congenital heart lesion, and the diagnosis is frequently made in young women of childbearing age. The management of this disorder during pregnancy has not been well studied. Our investigation reviews the outcomes of 42 pregnancies among 25 patients with MVP diagnosed before conception by the characteristic auscultatory and echocardiographic findings. All patients with no other cardiovascular disorder tolerated pregnancy well and developed no remarkable cardiac complications. Furthermore, the incidence of antepartum and intrapartum complications or signs of fetal distress was not greater when compared with pregnant patients with no known cardiac disorder (p greater than 0.05). Congestive heart failure occurred in one case in which premature labor with coexisting toxemia was treated with the combined intravenous administration of a beta adrenergic tocolytic drug, a glucocorticoid drug, and a large volume of fluids.
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PMID:Mitral valve prolapse and pregnancy. 727 Jun 25

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.
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PMID:Safe motherhood--a long way to achieve. 1147 55

An obstetric handbook was created in comic strip form in cooperation with the Ministry of Health in the region of Segou, Mali, for training of traditional midwives living far from community health centers. The drawings illustrate pregnancies at risk that the midwife should be able to identify in order to advise women to stay near the health facility before onset of labor. Drawings indicate pregnancies that are at risk because of the following: small stature, limping as a result of polio or sciatic paralysis, high parity, prior cesarean delivery, heart disease, overly large uterus, or prior stillbirth. Serious complications requiring referral to a health service are also illustrated and include severe anemia, genital bleeding, and signs of toxemia and edema. The midwife should accompany the woman during transport.
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PMID:[Obstetrical handbook in comic strip form]. 1229 24

In India, maternal and child deaths account for 60% of total mortality. Reductions in maternal mortality require the identification of all pregnant women in the community, prenatal care, the early detection of medical problems and pregnancy-related complications, tetanus toxoid immunization, identification of the most appropriate setting for delivery, prevention of maternal malnutrition, and motivation to practice breastfeeding and birth spacing in the postpartum period. To reduce child mortality, infants should be breastfed, immunization against common infectious diseases should be provided, and growth should be monitored at regular check-ups. As part of the village health worker's regular household visits, pregnant women should be motivated to seek prenatal care. Ideally, there should be a prenatal visit monthly for the 1st 7 months of pregnancy, once every 2 weeks until 36 weeks, and weekly thereafter. If long distance from a medical facility or the loss of wages make this impossible, there should be at least 4-5 visits at the 10th, 20th, 30th, 35th, and 35th weeks of gestation. Care should be taken to identify the major factors in high-risk pregnancies: moderate to severe toxemia, chronic hypertension, significant rental or heart disease, hydramnios or oligohydramnios, and uterine rupture. In areas where financial and human resources in the primary health care sector are limited, inputs should be targeted to high-risk groups and activities of preventive and therapeutic value that are most cost- effective. All interventions should be based on a thorough analysis of the major determinants of mortality, the incidence of specific diseases, the responsiveness of diseases to available technologies, the community's nutritional status, and the cultural milieu. Rather than create new schemes and categories of workers, existing health facilities should be fully utilized.
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PMID:Strategies for promoting child health. 1231 87


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