The management of the third stage of labour in women with heart disease

Cauldwell, Matthew; Steer, Philip; Swan, Lorna; Uebing, Anselm; Gatzoulis, Michael Α.; Johnson, Mark R.

doi:10.1136/heartjnl-2016-310607

Cited by 28 publications

(13 citation statements)

References 17 publications

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“…The third stage of labour is usually facilitated by the administration of syntometrine, which causes uterine contractions and minimises post-partum haemorrhage. However, this drug also has a pronounced hypertensive and vasoconstrictive effect and so is avoided in most women with heart disease in favour of a slow infusion of syntocinon (an oxytocin analogue) [ 82 ]. Misoprostol may be used for post-partum haemorrhage, with syntometrine reserved only for severe maternal haemorrhage where the benefit outweighs the risk [ 82 ].…”

Section: Pregnancy and Pre-deliverymentioning

confidence: 99%

Heart Disease and Pregnancy

Ashrafi

Curtis

2017

Cardiol Ther

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Cardiac disease remains a major cause of morbidity and mortality in pregnant and post-partum women, although progress has been made, with specialist joint obstetric–cardiology clinics providing an integrated, safe and personalised service to these women. As a result, fewer non-specialist cardiologists are managing women in pregnancy with cardiovascular disease. The aim of this review is to provide a brief overview of current knowledge and practice in the field, with an emphasis on the major physiological changes which occur during pregnancy, focussing on progress through the trimesters, clinical assessment in pregnancy, management of delivery (concentrating on managed vaginal delivery), drug treatment, key conditions and risk assessment. The latter factor is particularly important in terms of being able to identify high-risk women earlier and to counsel them appropriately. Pregnant women with cardiovascular conditions can, with appropriate knowledge and counselling, be managed safely in specialist multidisciplinary services, but there is a need for cardiologists to understand the key changes and risks involved in pregnancy, delivery and the post-partum period.

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Section: Pregnancy and Pre-deliverymentioning

confidence: 99%

Heart Disease and Pregnancy

Ashrafi

Curtis

2017

Cardiol Ther

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“…This is probably due to the cautious use of uterotonics as suggested by current guidelines, which advise the use of 2 IU of oxytocin due to its negative inotropic and positive chronotropic effects. This advice is supported by a recent study on the impact of a 2‐unit infusion of oxytocin given over 10 minutes in addition to a standard low dose infusion; women receiving the additional 2 IU infusion had a lower estimated blood loss at delivery (849 versus 505 ml) . There was no evidence of arrhythmia, ST segment change or alteration in maternal haemodynamics (blood pressure, heart rate, mean arterial blood pressure).…”

Section: Third Stage Of Labour and Antibiotic Prophylaxismentioning

confidence: 76%

The management of labour in women with cardiac disease: need for more evidence?

Cauldwell

Cox

Nelson‐Piercy

et al. 2017

BJOG

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“…The third stage of labour is usually facilitated by the administration of syntometrine, which causes uterine contractions and minimizes post-partum haemorrhage. However, this drug also has a pronounced hypertensive and vasoconstrictive effect and so is avoided in most women with heart disease in favour of a slow infusion of syntocinon (an oxytocin analogue) (Cauldwell et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Maternity Nurses’ Performance Regarding Management of the Intrapartum Woman With Cardiac Disease

Abd-Elhakam¹,

Salama²

2018

IJSN

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Background: Cardiac disease in pregnancy is a leading cause of maternal and neonatal morbidity and mortality. Effective management is based upon close fetal and maternal monitoring during pregnancy and labour. The aim of the present study was to evaluate maternity nurses’ performance regarding management of intrapartum woman with cardiac disease. Research design: A quasi-experimental design was utilized to fulfil the aim of the study. Sample: A convenient sample of a total 64 maternity nurses was included in the present study. Setting: The present study was conducted in Obstetrical and Gynecological Department at Benha University Hospital. Tools: Two tools were utilized for data collection. I-A structured interviewing questionnaire which include two parts; Part 1: Socio demographic characteristics. Part2: Assessment of nurses’ knowledge regarding cardiac disease during pregnancy and labour which includes Physiological changes of cardiovascular system during pregnancy. Causes and risk factors, etc. II-Maternity nurses' practice observational checklistwhich focus on management of cardiac women during labor including four stages of labour and Nursing care for moderate and high risk cases immediately after labour. Results: Shows significant improvement in nurses' knowledge 57.8% compared to 90.6% post intervention. Also, improvement is clear in satisfactory level of practice after intervention, in first stage for example was 32.8 % pre intervention compared to 87.5% post intervention. there were highly statistical significance differences between mean score of both knowledge and practice regarding management of intrapartum woman with cardiac diseases between the pre and post intervention phases (p<0.001).Conclusion: the study concluded that research hypotheses are supported and educational intervention had appositive effect on improvement nurses 'knowledge and practice and in turn their performance regarding management of intrapartum woman with cardiac diseases. Recommendation: Periodic educational program for nursing staff in Obstetrics and Gynecology Department regarding nursing care of cardiac patients.

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The management of the third stage of labour in women with heart disease

Abstract: The use of an additional 2 U of oxytocin for the management of third stage in women with HD had no cardiac consequences and was associated with a significantly lower blood loss. Further larger studies on a larger population of women with HD are needed.

Cited by 28 publications

References 17 publications

Heart Disease and Pregnancy

Heart Disease and Pregnancy

The management of labour in women with cardiac disease: need for more evidence?

Maternity Nurses’ Performance Regarding Management of the Intrapartum Woman With Cardiac Disease

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