Cardiovascular Disease Screening in Pregnancy

Sherman-Brown, Alice; Hameed, Afshan B.

doi:10.1097/grf.0000000000000565

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…A CVD screening algorithm for pregnant patients put forth by the California Maternal Quality Care Collaborative has been screening pregnant and postpartum individuals at each clinical encounter to encourage early evaluation and intervention. 4 This screen includes: tachycardia greater than 110 bpm, systolic BP less than 140 mm Hg, palpitations, dyspnea, orthopnea, persistent asthma, chest pain, wheezing, or crackles on examination. This patient's clinical status on presentation would have elicited a positive screen, prompting further investigation, preventing a missed cardiovascular event.…”

Section: Discussionmentioning

confidence: 99%

“… 2 SCAD disproportionately affects females of reproductive age 1 3 and is the most common mechanism of myocardial infarction (MI) in pregnancy. 4 5 Maternal complications have been reported in about 25% of patients and may lead to severe morbidity and even mortality. 2 Despite increased awareness of SCAD, guidelines to inform management are predominantly based on expert consensus.…”

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confidence: 99%

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Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

Nguyen Pham,

De Zoysa,

Ghoshhajra

et al. 2024

AJP Rep

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Due to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus.We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country.This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

Nguyen Pham,

De Zoysa,

Ghoshhajra

et al. 2024

AJP Rep

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“…Risk factors for CVD included maternal age > 40 years, pregestational body mass index (BMI) >35 kg/m 2 , black, Asian or minor ethnicities (BAME), pregestational diabetes, chronic hypertension, substance abuse (smoking, drugs, alcohol) and history of cardiotoxic chemotherapy 12 13…”

Section: Methodsmentioning

confidence: 99%

Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

et al. 2022

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ObjectiveTo appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal–fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes.MethodsA retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed.ResultsWe identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II–III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates.ConclusionsEven in a maternal–fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.

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“…Among the multitude of risk factors seen during pregnancy, of which obesity and hypertension play a major role, and the inequities of health care access faced by racial minorities and persons of lower socioeconomic/education status, there is a stark under-diagnosis of CVD which is likely contributing to the high rates of CVD-related maternal mortality in this country. Consequently, the American College of Obstetricians and Gynecologists (ACOG) endorses universal CVD screening for all women in the antepartum and postpartum period, specifically using the CVD in Pregnancy and Postpartum Toolkit Algorithm [ 6 , 14 ].…”

Section: Risk Factors Including Racial Geographic and Socioeconomic D...mentioning

confidence: 99%

“…If the patient screens positive for CVD, it warrants further workup with an EKG, BNP, and/or other diagnostic tests. Additionally, consultation with maternal fetal medicine and/or cardiology is recommended [ 14 ]. If results are negative, the patient simply receives reassurance and routine obstetric follow up is continued.…”

Section: Universal Cardiovascular Risk Assessment In Pregnancy and Po...mentioning

confidence: 99%

Screening for Cardiovascular Disease in Pregnancy: Is There a Need?

Chambers

Zoysa

Hameed

2022

JCDD

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Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to the overlap of normal pregnancy symptoms with those of CVD. Risk factors for CVD including race, advanced maternal age, hypertension, diabetes, obesity, socioeconomic status, and geographic region play an important role in CVD-related deaths. Several risk assessment models are available to stratify women with a known diagnosis of CVD. However, most women who die from CVD during pregnancy or the postpartum period do not have a prior diagnosis of CVD, and cardiomyopathy is an important contributor. The California Maternal Quality Care Collaborative (CMQCC) developed an algorithm to screen all pregnant and postpartum women to allow stratification into low or high risk for CVD. The algorithm has been validated in diverse patient populations. We propose universal CVD screening for all women in the antepartum and postpartum period to identify women at risk and to provide education and awareness for both patients and healthcare providers. This screening tool would work to reduce the increasing rates of severe maternal mortality and morbidity while having a significant impact on healthcare costs in the United States.

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Cardiovascular Disease Screening in Pregnancy

Cited by 6 publications

References 15 publications

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

Screening for Cardiovascular Disease in Pregnancy: Is There a Need?

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