The parturient with coronary heart disease

Area of Science:

• Cardiology
• Obstetrics
• Maternal Health

Background:

• Coronary heart disease (CHD) is a significant indirect cause of maternal mortality in the UK.
• There is limited level-one evidence guiding the management of pregnant women with CHD.

Observation:

• A case series of six pregnant women with CHD managed over one year.
• Five women had stable CHD, while one presented with unstable angina requiring percutaneous coronary intervention.
• Delivery methods varied, including elective cesarean sections under regional anesthesia and spontaneous vaginal deliveries.

Findings:

• Management decisions were guided by perioperative cardiac care guidelines and obstetric population guidelines.
• A multidisciplinary team approach was crucial for collaborative planning of pregnancy and delivery.
• Transthoracic echocardiography, alongside clinical assessment, proved valuable for risk stratification of peripartum cardiac events.

Implications:

• This approach facilitates tailored management strategies for pregnant women with CHD.
• Improved risk stratification can help prevent adverse cardiac events during the peripartum period.
• Further research is needed to establish level-one evidence for managing CHD in pregnancy.