1. The patient has to come under antenatal care in the early months of pregnancy; closer antenatal supervision is needed. A cardiologist is required to be consulted for the cardiac condition.
2. She should be advised to live within the limits of her cardiac reserve; she should work to an extent that will not make her short-of-breath. More rest should be advised as pregnancy advances with the provision of home-help and transport to and from the hospital.
3. The health of the patient has to be improved by correcting anaemia.
4. Bowel should be regularly opened by mild laxative, if necessary.
5. Exposure to cold and infection should be avoided as respiratory tract infection can precipitate cardiac failure. Oral tab. Fenocin forte (phenoxymethyl penicillin) 130mg (Pfizer Limited) one tab. twice daily or Inj. Penidure LA 12 (benzathine penicillin), Wyeth, every fortnightly as directed by the cardiologist needs to be continued throughout the pregnancy; and also puerperium for prophylaxis against recurrence of rheumatic fever.
She should be admitted in a hospital; for that, admission should be made about a fortnight before term in Grade 1 cases. For Grade 11 cases, she is advised to have antenatal rest by hospital admission at about the 28th week of pregnancy when the strain on heart seems to be the highest in pregnancy. Grade 111 cases are admitted without delay to improve cardiac deterioration. In Grade 1V cases, if pregnancy is allowed to continue, patient has to be kept in a hospital throughout the pregnancy. In general, she is expected to improve during last weeks of the pregnancy.
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