Perioperative management of pregnant women undergoing nonobstetric surgery

Article Figures & Data

TABLE 1

Benign cardiovascular findings in pregnancy

Physical examination

Increased intensity of arterial pulses

Cephalic and lateral displacement of the point of maximum impulse

Prominent splitting of the second heart sound

Systolic murmur in the pulmonary and tricuspid areas

Enhancement of preexisting murmurs

Systolic-diastolic murmur heard over 1 or both breasts (“mammary souffle”)¹⁰

Electrocardiogram

Left axis deviation

Left atrial dilatation

Q-wave and T-wave inversion in III

Q wave in aVF

T-wave inversion in V₁, V₂, and V₃

TABLE 2

Cardiac Disease in Pregnancy (CARPREG) II risk index

Predictor	Points
History of cardiac events or arrhythmia	3
Baseline New York Heart Association class III/IV or cyanosis	3
Mechanical heart valve	3
Decreased ventricular function	2
History of mitral or aortic valve dysfunction	2
Pulmonary hypertension	2
Coronary artery disease	2
Aortic disease	2
Late pregnancy assessment	1
No previous intervention for existing cardiac problem	1
Score	Incidence of adverse cardiac events

0 or 1	5%
2	10%
3	15%
4	22%
> 4	41%

Reprinted from Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease: The CARPREG II Study. J Am Coll Cardiol 2018; 71(21):2419–2430, copyright 2018, with permission from Elsevier. www.JACC.org

TABLE 3

Changes in laboratory values in pregnancy

Laboratory test	Change in pregnancy	Implication
Serum creatinine and blood urea nitrogen	Decrease due to increased glomerular iltration	Nonpregnancy normal values may indicate eveloping renal failure
Urine protein	Hyperfiltration leads to proteinuria	Small increases are normal, but > 300 mg/24 hours may indicate preeclampsia
Alkaline phosphatase	Increases due to placental production
Bilirubin and aminotransferases	Decrease	Nonpregnancy normal values of aminotransferases may indicate HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome
Thyroid-stimulating hormone	Decreases early, gradually normalizes	Free triiodothyronine and free thyroxine levels are stable and are better indicators of thyroid function than total values
Corticotropin and cortisol	Increase	Serum or salivary cortisol is not a reliable indicator of pathology