الفهرس 
Physiological Changes During PregnancyOnly 14 pages are availabe for public view
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Abstract
Normal pregnancy is associated with marked hemodynamic changes within the maternal circulation, which includes the increase in cardiac output and plasma volume and reductions in peripheral resistance and arterial pressure, together with marked alterations in the activity of various neurohumoral systems and in vascular and endothelial function.
Surgical intervention during pregnancy is indicated in many cardiac conditions including valve lesions, aneurysms, coronary disease and myxomas. Valvular heart disease is the most predominant, due to the high incidence of rheumatic affection in our community.
The principles for managing pregnant patients undergoing cardiac operation are similar to that for pregnant patients undergoing surgical intervention. These include paying attention to maternal well-being; avoid the use of teratogenic drugs, avoidance of fetal hypoxia and premature labor.
A few measures were recommended to decrease maternal and fetal mortality rates. These include avoiding functional deterioration during pregnancy, and sometimes providing earlier surgery to avoid the requirement for an emergency procedure; performing surgery with skilled surgeon, minimal extracorporeal circulation time; strict fetal monitoring and performing surgery during second trimester of pregnancy preferably.
The main concerns in the proper management of pregnant patients undergoing CPB are the control of temperature, maintenance of perfusion pressure, and the nature of the bypass flow.
There are a lot of problems that can occur in the immediate postoperative period. They include problems in hemostasis, cardiovascular and respiratory functions, less commonly, renal impairment and renal failure. In the pregnant patients, such problems, if severe, may require postoperative emergency cesarean section.
Following surgery, the risk of abortion or preterm labor is increased. Many studies have reported increased rates of spontaneous abortion and preterm labour.
Proper postoperative pain management could be obtained by systemic opioids or regional modalities. Regional analgesia is preferable because systemic opioids may decrease FHR variability. Early mobilization and prophylaxis against venous thrombosis should be considered as these patients are liable for thromboembolism.