Severe Cardiac Disease in Pregnancy

Cardiac conditions in pregnancy and the role of midwives: A discussion paper

“…In particular, hypoxaemia is poorly tolerated by the foetus and is associated with a high incidence of foetal loss, stillbirths, preterm delivery and IUGR. In these cases, the risk to mother and unborn child correlates with the former's resting oxygen saturation (Cox et al, ; van Mook & Peeters, ; Zöllner et al, ).…”

“…Mitral valve stenosis is the most common RHD valvular lesion observed in pregnancy to require invasive intervention such as open mitral valve commissurotomy or balloon valvuloplasty prior to or during gestation (van Mook & Peeters, ). Prophylactic antibiotics are administered in labour to women with valve disease or a history of endocarditis or increased risk of sepsis, and the guarded use of oxytocin infusion during the third stage is recommended (Curtis et al, ; SA Health, ).…”

“…Bradyarrhythmias are well tolerated, but some women will require insertion of a pacemaker (Ruys et al, ). The risk of arrhythmias peaks during labour and delivery when tachyarrhythmia (which is the most prevalent) requires prompt treatment using non‐teratogenic drug therapy or electrical therapy (Canobbio et al, ; van Mook & Peeters, ). Midwives will need to monitor closely the maternal heart rate during labour.…”

“…In these cases, the risk to mother and unborn child correlates with the former's resting oxygen saturation (Cox et al, 2005;van Mook & Peeters, 2008;Zöllner et al, 2013).…”

“…Cardiomyopathies in pregnancy include acquired and inherited diseases such as PPCM and toxic, hypertrophic, dilated, restrictive and idiopathic cardiomyopathies (Knight et al, 2016;van Mook & Peeters, 2008). Takotsubo syndrome, also known as "stress cardiomyopathy," previously reported in postmenopausal women, is a now potential cause for acute heart failure (AHF) in birthing (Kucia, Dekker, & Arstall, 2015;Minatoguchi et al, 2014).…”