Care in the puerperium
The mother with heart disease continues to be at risk during the puerperium. The first risk is from the major changes in fluid distribution and the diuresis that occurs secondary to the hormone changes following delivery of the placenta; this can destabilize the cardiovascular system. The second risk is that of thrombosis. The incidence of thrombosis is six times higher during pregnancy and 11 times higher in the puerperium than in the non-pregnant woman. Routine prophylaxis with low-molecular-weight heparin is now recommended for 7 days following caesarean section in all women, and will be additionally be recommended after a vaginal delivery to any woman with cardiac disease who has impaired cardiac output or whose mobility is in any way restricted.