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Visiting department: gynecological obstetrics treatment cost: the charging standards of different hospitals are inconsistent, and the cure rate of the top three hospitals in the city is about (1000-3000 yuan): treatment cycle: treatment method: drug treatmentGeneral treatment of heart disease during pregnancy
(a) Pregnancy management:
Prenatal examination should be strengthened for patients with cardiac function below Grade II, at least once every 2 weeks. Patients should have enough rest, avoid heavy physical labor, take a low-salt diet, pay attention to the prevention of respiratory tract infection, and those with anemia should be actively treated and admitted to hospital 2 weeks before the expected date of delivery. Patients with heart failure should be admitted to hospital immediately. Pregnant women have poor tolerance to foxglove drugs, so they should pay attention to toxic reactions, such as vomiting, slow pulse and chest pain. During pregnancy, it is best to take foxglove drugs with rapid effect and excretion, such as digoxin 0.25 mg, which should be taken orally for 2/day, and should be taken once after 2 ~ 3 days as appropriate. It is not required to reach saturation amount, so as to have room for increasing the dose in case of heart failure. Because it is difficult to master the long-term maintenance amount, those who are far away from the expected date of delivery can stop taking medicine after their condition improves, and can quickly turn foxglove if necessary after labor. Where the following circumstances, should try to terminate pregnancy:
1. Those with severe heart disease and compensatory function above Grade III;
2. Those who have a history of heart failure in previous pregnancy or have heart failure in early pregnancy;
5. Severe congenital heart disease and myocarditis. The method of termination of pregnancy, pregnancy within 3 months feasible abortion, > 12 weeks and【小于】15 weeks, if necessary, can be carefully considered with forceps curettage to terminate pregnancy. Induction of labor in middle pregnancy, especially when surgery is needed, is dangerous and should be avoided as much as possible. If conditions permit, pregnancy can continue under active treatment and observation. Where heart failure occurs, pregnancy must be terminated after heart failure is controlled.
(2) Treatment during childbirth:
Since 2000, it has been considered that the hemodynamic changes during cesarean section are smaller than those during vaginal delivery, and those with poor cardiac function can consider cesarean section under epidural anesthesia, and at the same time, cardiac monitoring can improve the cardiac condition after operation. Pregnancy complicated with heart disease
1. Do a good job in the ideological work of the puerpera in the first stage of labor and stabilize their emotions. Patients can take a semi-sitting position, and measure blood pressure, pulse and breath every half hour. Appropriate application of sedatives, such as Demerol, Phenamine, etc., so as to get spiritual comfort and eliminate fear and tension. If the pulse exceeds 120 beats per minute and the breath exceeds 28 beats per minute, it indicates that there is a precursor of heart failure, which should be actively treated, such as giving oxygen and giving cardiotonic drugs as soon as possible, etc., aminophylline, toxin anthocyanin K or cedilanid can be injected as appropriate, and morphine can be given if necessary. The usage is as follows:
① Aminophylline 250mg added to 25% glucose 20ml was slowly injected intravenously, which could be repeated after 4 ~ 6 hours.
② Intravenous injection of toxin K 0.125 ~ 0.25 mg in 20ml of 25% glucose (about 10 minutes). Pay attention to observe the heartbeat and pulse during injection. If arrhythmia and slow pulse occur, stop using it immediately. Give 0.125 mg after 4 hours if necessary.
③ Cedilanid 0.2-0.4 mg plus 25% glucose 20ml was slowly injected intravenously. Give 0.2 mg after 4 hours if necessary. Matters needing attention are the same as toxic trichloroside K.
④ When pulmonary edema occurs, 50% alcohol and oxygen can be inhaled for 20 ~ 30 minutes each time, which can eliminate foam in lung and trachea and can be used alternately with oxygen. 20 ~ 40mg furosemide was added with 20ml 25% glucose for intravenous injection. Diuretics began to take effect more than 15 minutes after injection, and reached its peak after 1 ~ 2 hours.
2. After the opening of the uterine orifice in the second stage of labor, use fetal head aspirator or forceps to deliver, and end the delivery as soon as possible, so as to avoid excessive exertion by the parturient. Hip traction should be performed when breech delivery is necessary. Pay attention to prevention and treatment of postpartum hemorrhage in the third stage of Immediately after the delivery of the fetus, sandbags weighing 1 ~ 2kg should be placed in the abdomen (or pressed by hand) to prevent the peripheral circulation failure caused by a large amount of blood pouring into visceral blood vessels due to the sudden decrease of abdominal pressure. Subcutaneous injection of morphine 10mg, or Demerol 50 ~ 100mg, so as to rest quietly. In order to prevent and treat postpartum hemorrhage, oxytocin can be injected intramuscularly for 10 ~ 20u when necessary. Ergositine can increase venous pressure and should be avoided as much as possible.
(3) Puerperal treatment:
Do not move the parturient immediately after delivery, observe closely, and the condition is stable after 2 hours, so you can send it back to the ward. Within 3 days after delivery, especially within the first 24 hours, we must strengthen observation, guard against heart failure, and make all preparations for rescue. Postpartum should stay in bed for two weeks, and those with heart failure should be prolonged as appropriate. Generally, it is advisable not to breastfeed, and those without heart failure can breastfeed as appropriate. Postpartum infection and subacute bacterial endocarditis are easy to occur, so antibiotics can be used prophylactically. People with mild illness should pay attention to contraception; Sterilization should be advised for those who are not suitable for reproduction. The operation can be carried out about one week after delivery. At this time, the heart condition has become stable and the physical strength has basically recovered. PostpartumThe infection has been ruled out. Patients with heart failure should be controlled first, and then sterilized at an elective time.
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