Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It has long been known or suspected that phenytoin and probably phenobarbitone prescribed in pregnancy may lead to fetal malformations. The use of troxidone for epileptic women during pregnancy was reported in 1970 to lead to malformations. Over 50 instances of pregnancy in women taking troxidone have since been reported. In 8 of these the drug was used alone. 13 pregnancies resulted in abortion and 33 of the 40 survivors had a minor congenital anomaly, leading to death in 14. Complex congenital heart lesions with patent ductus, septal defects and aortic hypoplasia were apparent in half the survivors. Malformed or low-set ears were seen in nearly half the cases, palatal deformities were less common and evidence intrauterine growth retardation was frequently present. A 29-year-old mother taking troxidon and carbamazepine, and with a history of hypertension and proteinuria dating back to adolescence, delivered her first child prematurely. The child was small, showed deformed ears, displayed feeding problems and was found to be in cardiac failure with a systolic murmur and absent femoral pulses. Postnatal growth was retarded and after further cyanotic attacks a cardiac catheter study was performed. This showed a hypoplastic aortic arch with an anomolous origin of the left subclavian artery and patent ductus arteriosus, findings similar to those previously reported in neonates following maternal use of troxidone.
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PMID:Troxidone (trimethadione) embryopathy: case report with reveiw of the literature. 55 Sep 45

The early diagnosis of heart disease during or better before pregnancy is one of the most important problems, as cardiac diseases are the most common cause for maternal deaths throughout the world. The knowledge of hemodynamic alterations in circulatory and respiratory physiology during pregnancy complicated by heart disease is a prerequisite for their management. The following indications for therapeutic abortion of pregnancy complicated by heart disease can be concluded according to our own observations: 1. history of significant heart failure (more than grade IV according to the classification of the New York Heart Association), frequent attacks of angina pectoris and longstanding cyanosis: 2. in spite of the most careful heart treatment with digitalis, diuretics and salftree diet cardiac-thorax-rate of more than 55% in congenital heart disease, cardiac-thorax-rate of more than 60% in acquired heart disease, significant signs of heart failure, namely more severe than grade III, tachycardic atrial fibrillation, pulse deficit of more than 30/min, active inflammatory processes of the heart (rheumatic fever, subacute bacterial endocarditis, Takayasu's disease); 3. especially severe metabolic disorders, i.e. diabetes mellitus, malignant hypertension, kidney diseases; 4. primiparae of an age of more than 35 years with any heart disease. Commissurotomy can be accomplished during pregnancy if it is too late for therapeutic abortion. Pregnancy in case of artificial valves is not recommended in general because of impending hemorrhagic diathesis.
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PMID:[Indication for pregnancy interruption in patients with heart diseases]. 85 89

49 cases of myocardial infarction during pregnancy are reviewed from the literature, considering the frequency, pathogenesis, clinical findings, prognosis, treatment, obstetrical conduct including whether abortion is indicated, and finally 17 cases of pregnancy in women with previous heart attacks are summarized. A myocardial infarction is rare, about .01-.075%, more frequent in late pregnancy or the postpartum, and in older women. This series averaged 32.9 years. 88% were due to atherosclerosis. Other risk factors were usually not reported systematically. 56% of the incidents were the 1st heart attack; 44% were preceded by angina; 68% were anterior. Pregnancy affects the EKG and white blood count, but serum enzymes are the same as in nonpregnant women. 29% of these women died, 23 went to term, and 7 gave birth prematurely. 13 labors were spontaneous, 7 required forceps, and 10 were Caesarean births. Fetal loss was 27%. Treatment is the same as that in any heart attack patient, except for lignocaine and use of anticoagulants. Abortion is only necessary in cardiac insufficiency. Delivery should probably involve forceps, epidural anesthesia, and anticoagulatns immediately after delivery, but oxytocin should be avoided. The 17 cases of pregnancy after a heart attack resulted in 1 abortion, 15 term deliveries, 3 new infarctions, and 1 death due to antoher heart attack at term.
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PMID:[Myocardial infarct and pregnancy]. 103 53

Human parvovirus B19 is a recently recognized cause of hydrops fetalis. It is a small, single-stranded DNA virus, which preferentially infects late erythroid precursors and produces red blood cell (RBC) aplasia, fetal anemia, and cardiac failure. Infection is accompanied by characteristic intranuclear inclusions in fixed and circulating RBC precursors. These inclusions have been shown to contain virus particles by electron microscopy and in situ hybridization. Infection of the fetus, mother, and newborn infant can be diagnosed by serological and molecular methods selected to match the stage of the infection. Recent work has shown that parvovirus B19 can infect cells other than erythroid precursors, and that additional mechanisms such as myocarditis may contribute to hydrops fetalis in some cases. Infected fetuses are not always hydropic. Maternal infection results in increased abortion and stillbirth even in the absence of transplacental transmission, which occurs in approximately one third of infected mothers. The overall risk of fetal loss following maternal exposure is much less than previously thought, and may be less than 3% in the first 20 weeks of gestation or approximately 10% if the mother is actually infected. Although parvoviruses are teratogenic in animals, there is no evidence that B19 is a significant teratogen in man. The long-term outlook of survivors of intrauterine infection, including those successfully treated by intrauterine blood transfusion, appears to be good, but requires further study.
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PMID:Parvovirus infection of the human fetus and newborn. 156 88

2 studies have been done in China: 1) a longitudinal study on maternal mortality in Beijing from 1949 to 1983; and 2) a cross-sectional study on maternal mortality in the year 1984 in 21 of 29 provinces, municipalities, and autonomous regions. A maternal and child health network for care and referral of abnormal cases was set up with ambulances and transfusion facilities in place and training for traditional birth attendants. Aseptic delivery reduced the number of deaths due to sepsis from 213/100,000 live births to 4.2 in 5 years and to 0 in 9 years. Deaths from hemorrhage (including ruptured uterus) dropped by 86% in 5 years. With legalized abortion came a dramatic fall in maternal mortality from 685,100/000 live births to 15, a decrease of 98%. In 1949, 27% of women who died in childbirth had received hospital care; another 27% had no cure. In 1958, however, 80% of the fetal cases had obtained hospital care; the remaining 20% had been seen by a traditional practitioner or health worker. From 1959-68, the total maternal mortality was 1.3-28.1/1 00,000. From 69-78, the turmoil of the cultural revolution had "ill effects" on maternal and child health but by 1979, order was brought back again. The cross-sectional study covered a population of about 177 million. About 2.5 million live births occurred. 1211 maternal deaths were registered for a maternal mortality rate of 48.4/100,000. Maternal mortality varied a good deal in different parts of the country--from 17.7 in Shanghai to 108.2 in the region of the Hai people in Ningxia in northwest China. Maternal mortality rates correspond roughly to the level of economic development. The 5 main causes of death were hemorrhage, heart failure, pregnancy- induced hypertension (including eclampsia), postpartum infection and liver failure.
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PMID:Maternal mortality in China. 263 3

This study was undertaken to clarify the long-term post-operative state of patients with tetralogy of Fallot (TF). Total number of 243 patients with TF who underwent corrective surgery between 1965 and 1984 were investigated by the follow-up study. Cardiac function was evaluated by Holter ECG (for 48 patients), Treadmill exercise tolerance test (for 74 patients), and cardiac catheterization (for 56 patients). Twenty-year's follow-up revealed 13 patients (5.3%) of late deaths, and 10 of them were cardiac deaths. Three patients (1.2%) expired by sudden death. Nineteen female patients experienced 26 deliveries. No patients required artificial abortion due to heart failure during pregnancies. No baby with cardiac anomaly was born by these mothers. Holter ECG showed complex ventricular arrhythmias in 23 patients (48%). The high systolic pressure ratio of right ventricle to aorta, the old age at surgery, and the long elapsed time after surgery, were the three major aggravating factors of complex ventricular arrhythmias after the correction of TF. Treadmill tests disclosed that patients with poor exercise tolerance had low RVEF and high RVEDP, indicating that RV dysfunction limited the exercise capacity in the long-term postoperative state. Among the three methods of RV outflow tract reconstruction, the follow-up data showed that patients with right ventricular patch below pulmonary valve had better event-free rate compared to those with transannular patch or to those with extensive muscle resection without patch enlargement. Cineangiogram revealed that patients with transannular patch had biventricular enlargement, but the cardiac function did not differ among the three RV outflow reconstructive methods. Because 15 years after surgery the event-free rate decreases gradually and the arrhythmia problem becomes prominent, it is concluded that patients with TF should be followed and observed carefully even though they are currently in the healthy state.
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PMID:[Evaluation of long-term postoperative status and cardiac function in patients with tetralogy of Fallot]. 280 8

3 cases of copper IUDs recovered during laparotomy from the sigmoid colon are presented. One woman was a 24-year old mother of 5 who had had 2 cesarean sections since the disappearance of her Cu-7 IUD in 1980. She had right upper quadrant abdominal pain for 1 year with gall bladder stones. The IUD was found lying 80% in the gut lumen. After colotomy she recovered. The 2nd woman was 31 years old, pregnant for the 4th time after failure of her IUD. She was experiencing a constant left iliac fossa ache. The IUD was shown to be extrauterine by ultrasound, could not be seen at laparoscopy, and was removed by colotomy. The 3rd woman was a 37-year old mother of 5, 19 weeks' pregnant, having a septic miscarriage on admission. She had labor induced, but the IUD was not expelled. Her pain worsened, and fever and tachycardia persisted. Emergency laparotomy revealed a perforated posterior uterine wall with the Cu-7 eroding the serosa of the sigmoid colon. It was removed but the defect was not repaired. She required a subtotal hysterectomy, and a second laparotomy with a temporary colostomy, and her recovery was complicated by pulmonary embolism and cardiac failure. These cases draw attention to the importance of proper management of patients with no visible IUD thread. Ultrasound, and if necessary x-rays and laparoscopy should precede laparotomy. Expulsion of an IUD is rarely unnoticed, nor should pregnancy with an IUD be assumed to be due to an expelled device.
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PMID:Recovery of the intrauterine contraceptive device from the sigmoid colon. Three case reports. 304 19

There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.
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PMID:Maternal mortality in Bahrain with special reference to sickle cell disease. 321 81

A retrospective review of maternal mortality in the obstetric unit of Bangkok's Ramathibodi Hospital in 1969-82 was conducted. In this 14-year period, there were 72,872 live births and 26 maternal deaths, yielding a maternal mortality rate of 0.4/1000. Direct obstetric causes accounted for 77% of these deaths. The distribution of the 20 direct obstetric deaths was as follws: septic abortion (10 cases), puerperal infection (3 cases), pre-eclampsia (1 case), eclampsia (2 cases), amniotic fluid embolism (3 cases), and placenta percreta with uterine rupture (1 case). Among the 6 deaths attributable to indirect causes, viral hepatitis was responsible for 3, systemic lupus erythematosus was the cause in 2 cases, and cardiac failure occurred in the final case. The maternal mortality rate was 0.8/1000 amond women 19 years of age and below and 0.6/1000 among women 35 years of age and above compared with 0.2/1000 among those 20-34 years of age. Maternal mortality was 0.6/1000 for cesarean section delivery compared with 0.1 for normal delivery. Ongoing statistical analyses of maternal mortality are urged to serve as the basis for preventive measures.
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PMID:Maternal mortality in Ramathibodi Hospital: a 14-year review. 383 Dec 6

Cardiological indications for abortion, and the indications for heart surgery during pregnancy are discussed. Conservative treatment of mitral, aortic, and pulmonary valve disease is considered preferable to cardiac surgery during pregnancy, and in stable cases, the risks are not unduly high. In open ductus arteriosus, where the shunt volume is moderate, the prognosis for conservative treatment is also quite good. Where heart surgery during pregnancy does seem indicated (as in severe heart valve disease with cardiac insufficiency) the risks of heart surgery during pregnancy must be weighed against those of abortion followed by surgery.
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PMID:[Discussion on the article Otto. (Indications for heart surgery in pregnancy and during labor, Zbl. Gynak. 96, 44-50, 1974)]. 440 46


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