Abstract book 6th RMS 16.indd

• Undertake baseline thyroid function
tests (TFTs) as soon as possible
• Use pregnancy specific reference ranges
when interpreting TFTs
• TFTs every 3 months; more frequently if
dosage adjustments made
• Routine increases in thyroxine not
required; make dosage adjustments
based on TFT results
• Avoid taking iron supplements at the
same time as oral thyroxine
• Check absorption/compliance in those
with vomiting
• If clinically euthyroid with subclinical
hypothyroidism - early thyroxine treatment
appears to reduce the miscarriage
rate
• If clinically euthyroid and thyroid antibody
positive - monitor TSH levels and
only give thyroxine if patient becomes
hypothyroid
Labour/delivery:
• Large maternal goiter may cause anesthetic
complications Postnatal:
• Observe for signs of post-partum
thyroiditis
• Screen for post-partum depression
132
Thrombophilia and Pregnancy
Zarko Alfirevic MD (UK)
This lecture will discuss indications to
test for common inherited and acquired
thrombophilias, most recent management
strategies and implications for research in
this complex field.
133
Autoimmune Disease and Pregnancy
Mazen Zebdeh MD (Jordan)
134
Heart Disease in Pregnancy
Wael Husami MD (USA)
Heart Disease complications rate is 4% of
pregnancies in women without preexisting
cardiac abnormalities. Advances in
medical and surgical therapies make
Congenital Heart Disease in pregnancy and
increasingly common phenomenon. That
advancement has yielded a population
of women of childbearing age with
heart disease requires an experienced
multidisciplinary team approach including
Cardiologists, Obstetricians, Primary care
providers, Midwives and Tertiary care
center. The evaluation and management
of heart disease in the pregnant patient
requires an understanding of the normal
physiological changes associated with
gestation, labor, delivery, and the early
postpartum period. (1)
Congenital heart disease and valvular heart
lesions associated with high maternal and
fetal risk during pregnancy. However, many
patients with CHD and valvular heart disease
can be successfully managed throughout
pregnancy and during labor and delivery
with conservative medical measures
designed to optimize intravascular volume
and systemic loading conditions. Some
woman may need prosthetic valves and
the performance of cardiac valve surgery
is a complex undertaking in the pregnant
patient. (1) Recommendations for choice
of the prosthetic heart valves are based
on the durability of prosthesis, necessity
for anticoagulation, risk of thromboembolism
and bleeding, re-operation
rate, hemodynamic performance of
the prosthesis and possible future
pregnancy. Women with prosthetic
heart valves exhibit a heightened risk of
thromboembolic events during pregnancy.
Anticoagulation with warfarn provides
protection against these complications,
but the use of this drug increases the risk
of embryopathy. While pregnant women
with bioprosthetic valves are typically
spared the need for anticoagulation, they
have a higher incidence of valve failure
than nonpregnant patients. Thus, the
approach to management of pregnant
women with prosthetic heart valves differs
in some ways from that of other patients.
(2) The clinical management of pregnant
women with prosthetic heart valves during
pregnancy has been difficult and the
use of anticoagulation continues to be
problematic. (3)
The ACC/AHA guidelines recommend
warfarin as the anticoagulant of choice
in this patient group through the 35th
week of pregnancy. After the 36th week,
however, heparin should be substituted
for warfarin; should warfarin continue
to be used, a caesarian section should
be performed to reduce the risk to the
anticoagulated infant. The guidelines do
not yet recommend any use of LMWHs;
it has been suggested that their use be
limited to patients with contraindications
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