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Cardiac disease in pregnancy
Martin Lupton1, Eugene Oteng-Ntim, Gubby Ayida
1Department of Obstetrics/Gynaecology, Chelsea and Westminster Hospital, London, UK.
Current Opinion in Obstetrics & Gynecology
|March 27, 2002
Summary
Pregnancy with congenital heart disease (CHD) is more common due to medical advances. Multidisciplinary care is crucial for managing risks to both mother and fetus.
Area of Science:
- Cardiology
- Obstetrics
- Genetics
Background:
- Congenital heart disease (CHD) in pregnancy is rising due to improved treatments allowing more women to reach reproductive age.
- Specific conditions like pulmonary hypertension and cyanotic heart disease pose significant maternal mortality risks (up to 50%).
- Managing anticoagulation for artificial valves requires careful consideration of risks to mother (warfarin) and fetus (heparin).
Purpose of the Study:
- To review the evolving landscape of congenital heart disease in pregnant individuals.
- To highlight the risks and management strategies for pregnant women with CHD.
- To emphasize the importance of tailored antenatal counseling and multidisciplinary care.
Main Methods:
- Review of current medical literature and clinical guidelines.
- Analysis of risks associated with various maternal cardiac lesions.
- Discussion of management challenges, including anticoagulation and fetal risks.
Main Results:
- Maternal mortality risk varies significantly with the type of CHD, reaching up to 50% in severe cases.
- The risk of fetal congenital heart disease is elevated (2- to 20-fold) depending on the maternal condition.
- Peripartum cardiomyopathy and Marfan's syndrome may carry lower risks than previously assumed.
Conclusions:
- Antenatal counseling must be individualized based on the specific cardiac lesion.
- Pregnancy and postpartum care for women with CHD requires a multidisciplinary team approach.
- Specialized tertiary centers are recommended for optimal management of these complex cases.