Acute left heart failure with pulmonary edema as the main manifestation is more common

Difficulty breathing, orthopnea with a sense of suffocation, restlessness, coughing and coughing up white or pink frothy sputum

There are scattered wet rales at the bottom of both lungs. In severe cases, both lungs are full of wet rales and accompanied by wheezing.

Chronic left heart failure is characterized by dyspnea as the main manifestation

The main manifestations of chronic right heart failure include abdominal fullness, lack of appetite, nausea and vomiting, jugular venous distension, positive hepatic-jugular reflux sign, and edema.

subjective functional capacity

Objective means of inspection

The circulating blood volume of pregnant women reaches its peak at 23 to 34 weeks. The increase in total circulating blood volume can cause increased cardiac output and accelerated heart rate, aggravating the heart load.

Every time a woman contracts during labor, 250 to 500 ml of fluid is squeezed into the systemic circulation.

During the puerperium, especially within 3 days after delivery, uterine contractions cause a large amount of blood to enter the systemic circulation, and the fluid retained in the tissue spaces also begins to flow back, resulting in an increase in systemic circulation blood volume.

Diagnosis of abnormal heart rate, myocardial ischemia, myocardial infarction and the location of infarction

Provides duration and frequency of arrhythmia

Accurately reflects changes in the size of each heart chamber, heart valve structure and function

Myocardial enzyme and troponin tests indicate whether there is myocardial damage The detection of brain natriuretic peptide can be used as an effective heart failure screening and prognostic indicator.

Assess fetal health

After 32 weeks of pregnancy, you need to check once a week, and you should be hospitalized in advance to wait for delivery at 36 to 38 weeks.

Early manifestations of heart failure

Get adequate rest and sleep for at least 10 hours a day. When resting, sleep mainly on the left side or semi-recumbent position to avoid overwork, mental stress and emotional agitation.

The nutrition is scientific and reasonable. It is appropriate not to exceed 12.5kg during the entire pregnancy. Generally, the daily salt intake should not exceed 4~5g. Eat small and frequent meals to prevent constipation from aggravating the burden on the heart.

Prevent and treat various factors that induce heart failure, such as infection, anemia, pregnancy-induced hypertension, thromboembolism, etc.

Provide guidance to pregnant women and their families on relevant knowledge

If pregnancy is not suitable, the pregnancy should be terminated. In early pregnancy, therapeutic abortion should be performed before 12 weeks of pregnancy

Those with low risk of pregnancy due to heart disease and Class I heart function can carry their pregnancy to term.

Heart disease patients with higher pregnancy risk but cardiac function class I can terminate their pregnancy at 32 to 36 weeks.

Patients with severe heart disease who are contraindicated in pregnancy need to terminate the pregnancy as soon as possible once diagnosed

Pregnant women should sit in a semi-recumbent or upright position with their legs drooping to reduce venous blood return.

Immediately inhale high-flow oxygen, and adjust the oxygen flow according to the results of arterial blood gas analysis

Open the intravenous channel and use cardiotonic drugs as directed by the doctor

Those with cardiac function levels I to II, a small fetus, a normal fetal position, and good uterine cavity conditions can undergo vaginal delivery to avoid excessive birth.

Those with cardiac function levels III to IV, a relatively large fetus, poor uterine cavity conditions, and other complications are not suitable for vaginal delivery and may be given elective cesarean section.

Patients with structural abnormal heart disease need to take prophylactic antibiotics for 1 to 2 days before cesarean section.

Lie on your left side and avoid lying on your back. During delivery, adopt a semi-recumbent position, raise the buttocks and lower the lower limbs, and avoid holding the mother's breath during the operation.

After the fetus is delivered, a sandbag should be placed immediately on the abdomen for 24 hours to prevent heart failure caused by a sudden drop in abdominal pressure.

During the first stage of labor, blood pressure, pulse, respiration, and heart rate were measured every 15 minutes, and fetal heart rate was measured every 30 minutes.

Measure every 10 minutes during the second stage of labor

Follow the doctor's advice to inject oxytocin intravenously or intramuscularly, and ergometrine is prohibited to increase cubic venous pressure.

Pregnant women in semi-recumbent or left-side lying position

Early moderate activity to reduce thrombosis

Vital signs, chief complaints and cardiac function status to correctly identify early symptoms of heart failure

Continue to use oxytocin after delivery

Low molecular weight heparin can be administered subcutaneously in the first few days after surgery

Antibiotics prevent infection for 5 to 10 days

Women with cardiac function levels I to II can breastfeed, but should avoid overexertion.

People who have taken warfarin for a long time and have heart function level III or above should not breastfeed, and those who have lactation withdrawal should not use estrogen.

Pregnant women with pregestational diabetes should be checked once a week in the early stages, once every 2 weeks after the 10th week, and once a week after 32 weeks of pregnancy.

GDP pregnant women: blood sugar levels before meals and 2 hours after meals are ≦5.3mmol/L or ≦6.7mmol/L respectively Nighttime blood sugar should not be lower than 3.3mmol/L HbA1c during pregnancy should be <5.5%

Pregnant women with PGDM: Do not control blood sugar too strictly in early pregnancy to prevent hypoglycemia. Its pre-meal, nighttime and fasting blood sugar should be controlled at 3.3~5.6mmol/L Postprandial blood sugar peak value is 5.6~7.1mmol/L HbA1c＜6.0%

Nutritional therapy is the most important method in treating gestational diabetes

Control total energy, have balanced nutrition, eat small amounts with frequent meals, and emphasize eating before meals.

Eat a light, low-fat, low-fat, low-salt, high-fiber diet, and prohibit the intake of refined sugar.

Reflect the characteristics of personalization and security

Preferred blood insulin for drug treatment

For those with high blood sugar (>16.6mmol/L), first give a one-time intravenous injection of insulin.

0.9% sodium chloride injection, continuous intravenous drip of insulin

Monitor blood sugar once every hour since taking insulin, and make adjustments according to the drop in blood sugar. The average blood sugar drop per hour is 3.9~5.6mmol/L.

When blood sugar drops to 13.9mmol/L, change the 0.9% sodium chloride injection to 5% glucose or glucose saline

If blood sugar is well controlled and there are no maternal or fetal complications, the pregnancy can be terminated after 39 weeks of pregnancy under close monitoring.

cesarean section

For those with diabetes before pregnancy, intravenous infusion of 0.9% sodium chloride injection plus insulin

For patients undergoing cesarean section, subcutaneous insulin injection should be stopped and replaced with low-dose insulin and continuous intravenous infusion. Control blood sugar during the operation at 6.7~10.0mmol/L, and measure blood sugar every 2~4 hours after the operation until the diet is restored.

When a newborn is born, umbilical cord blood is taken to monitor blood sugar, and peripheral blood sugar is monitored within 30 minutes after birth.

The dosage of insulin should be reduced to 1/3~2/3 of that before delivery, and the dosage should be adjusted according to postpartum fasting blood sugar

Avoid heavy physical labor and get enough sleep. Increase the intake of high-quality protein, high vitamins, rich in carbohydrates, and low-fat foods to maintain smooth bowel movements

People with chronic HPV infection need to check their liver function regularly after pregnancy

Inject vitamin K1 intramuscularly a few days before delivery, and use oxytocin immediately after delivery of the fetal shoulder to prevent postpartum hemorrhage.

All users use 200mg/L chlorine-containing preparations for soaking

Breastfeeding is prohibited during the acute phase of hepatitis and severe hepatitis. Estrogen is prohibited for lactation withdrawal. You can choose to take raw malt orally or apply Glauber's salt to the breast externally.

Pregnant women should intramuscularly inject 2~3ml of gamma globulin within 7 days, and the newborn should be injected with gamma globulin once at birth and 1 week after birth.

Start antiviral treatment at 24 to 28 weeks of pregnancy, and inject hepatitis B immune globulin as soon as possible within 12 hours after birth.

Reduce hospital-borne infections

Consume iron-rich foods such as animal blood, liver, and lean meat Consume dark-colored vegetables and fruits rich in vitamin C to promote iron absorption and utilization

Those with hemoglobin above 70g/L can take oral iron supplements and take vitamin C at the same time to promote iron absorption. They should be taken after or with meals.

For those with hemoglobin <70g/L, give blood transfusion Hemoglobin is between 70 and 100g/L, and blood transfusion is decided based on whether the patient has surgery and heart function.

Hemostatic agents (vitamin C, vitamin K1) are given before and after delivery. Prostaglandin preparations can be used after the placenta is delivered to prevent postpartum hemorrhage. At the same time, uterine infusion should be used for at least two hours.