Heart Disease and Pregnancy

Abstract

Cardiac disease remains a major cause of morbidity and mortality in pregnant and post-partum women, although progress has been made, with specialist joint obstetric–cardiology clinics providing an integrated, safe and personalised service to these women. As a result, fewer non-specialist cardiologists are managing women in pregnancy with cardiovascular disease. The aim of this review is to provide a brief overview of current knowledge and practice in the field, with an emphasis on the major physiological changes which occur during pregnancy, focussing on progress through the trimesters, clinical assessment in pregnancy, management of delivery (concentrating on managed vaginal delivery), drug treatment, key conditions and risk assessment. The latter factor is particularly important in terms of being able to identify high-risk women earlier and to counsel them appropriately. Pregnant women with cardiovascular conditions can, with appropriate knowledge and counselling, be managed safely in specialist multidisciplinary services, but there is a need for cardiologists to understand the key changes and risks involved in pregnancy, delivery and the post-partum period.

The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high‐income setting: a prospective cohort study

“…Pregnancy is associated with marked changes in the cardiovascular system including a 40–50% increase in plasma volume and cardiac output, variations in systemic vascular resistance and mean arterial blood pressure, and an increase in atrial and ventricular diameter and volume . In addition, pregnancy is a hypercoagulable state leading to an increased risk of thromboembolism .…”

Maternity Nurses’ Performance Regarding Management of the Intrapartum Woman With Cardiac Disease

“…Post-partum follow-up also allows for the reintroduction of important cardiac medications whose use may have been altered during pregnancy, such as angiotensin-converting enzyme inhibitors or warfarin. Also Post-partum is a key opportunity to discuss contraception and the options available to women to reduce the risk of an unplanned pregnancy, as well as to allow recovery from the most recent pregnancy, especially in the context of peripartum cardiomyopathy ( Reza et al, 2017).…”

Assessment of outcomes of heart diseases in pregnancy: A cross sectional study in tertiary healthcare teaching institute in metropolitan city

“…Though mortality rates are lower, heart diseases in pregnancy are the important indirect cause of maternal mortality globally. 1 Many poor countries are facing heart diseases in pregnancy as a public health concern. Although the reported incidence varies between 0.1 and 4%, 1-3 cardiac disease remains a significant cause of maternal death worldwide.…”

“…2 Based on the location of the mother, variation in disease rates and epidemiology were observed. 1 Worldwide, hypertensive disease in pregnancy is by far the most prevalent cardiovascular disorder, complicating 2-8% of all pregnancies in the Western world. Rheumatic heart disease is common in developing countries but are now rare in the Western world.…”

“…Rheumatic heart disease is common in developing countries but are now rare in the Western world. 1 Heart diseases in the pregnancy may present challenges in management of pregnancy, since pregnancy is associated with various physiologic changes on cardiovascular systems i.e. an increase in plasma volume and cardiac output by almost half times, 17% increase in resting pulse.…”