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The contribution of heart disease to maternal mortality
Julia Zöllner1, Ruth Curry, Mark Johnson
1Academic Obstetrics and Gynaecology, Imperial College bInstitute for Women's Health, University College London, London, UK.
Insights
Managing heart disease in pregnancy requires careful multidisciplinary assessment to optimize maternal health and minimize risks. This approach ensures safer pregnancies for women with pre-existing cardiac conditions.
Area of Science:
- Cardiology
- Maternal Health
- Obstetrics
Background:
- Heart disease is a significant global cause of maternal mortality.
- Causes vary by region: myocardial infarction, cardiomyopathy, and congenital heart disease in Western countries; rheumatic heart disease in developing nations.
Purpose of the Study:
- To review best practices for managing pregnant women with pre-existing heart disease.
- To highlight the importance of multidisciplinary care and risk assessment.
Main Methods:
- Review of existing literature and clinical guidelines.
- Emphasis on pre-pregnancy assessment by a multidisciplinary team.
- Description of in-pregnancy surveillance and care levels.
Main Results:
- Few prospective studies exist for guiding management.
- Pre-pregnancy optimization includes clinical assessment, medication review (avoiding teratogens), and patient counseling.
- In-pregnancy care involves defining surveillance needs, with some women managed peripherally and others requiring tertiary center care with echocardiography.
Conclusions:
- Most women with pre-existing heart disease can achieve safe pregnancies.
- Close attention to detail and proactive management are crucial for preventing complications.
Purpose Of Review:
Heart disease is a leading cause of maternal death worldwide. In western countries, the principal causes of death from heart disease are myocardial infarction, cardiomyopathy and congenital heart disease, whereas in developing countries, rheumatic heart disease and its long-term consequences are more important.
Recent Findings:
There are few prospective studies upon which to base the management of these complex cases. However, best practice includes the assessment of women prepregnancy by a multidisciplinary team, with the aim of optimizing the clinical state, changing therapy to avoid teratogenic treatments and advising the patient and her relatives about the potential risks and possible complications that may arise. During pregnancy, the multidisciplinary team should define the level of care/surveillance required in each case. Some women may be safely looked after in a peripheral hospital, whereas others may need to be seen by the multidisciplinary team in the tertiary centre at regular intervals along with close echocardiographic monitoring.
Summary:
The majority of women with preexisting heart disease can go through pregnancy safely, however, close attention to detail must be paid to avoid potential complications.
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