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Myocardial infarction during pregnancy: a team challenge
1Department of Nursing, University of New Hampshire, Durham 03824.
Myocardial infarction during pregnancy is rare but may be increasing in frequency because of the trend toward later childbearing and an overall increase in risk factors for women (smoking, high-stress careers). The physiologic changes and stresses of pregnancy and labor provide a unique and often devastating setting for coronary diseases. The mortality rate is extremely high, approaching 40% if delivery ensues within 2 weeks of infarction. A planned, induced labor with regional anesthesia and continuous invasive monitoring in a well-equipped medical center provides the safest setting for delivery. Assisted vaginal delivery may offer a lower risk of death than cesarean section. The nurse, as well as the other members of the multidisciplinary team, should be well versed in the normal physiologic stresses of pregnancy. The fetal and cardiac effects of all medications and interventions must be explored. The almost simultaneous appearance of a new child in one's life with a heightened and immediate awareness of one's own mortality can lead to overwhelming feelings of despair and anxiety. Transition to home life may be difficult. All aspects of the patient's needs from heart to hope, should be addressed.
Myocardial infarction during pregnancy is rare but may be increasing in frequency because of the trend toward later childbearing and an overall increase in risk factors for women (smoking, high-stress careers). The physiologic changes and stresses of pregnancy and labor provide a unique and often devastating setting for coronary diseases. The mortality rate is extremely high, approaching 40% if delivery ensues within 2 weeks of infarction. A planned, induced labor with regional anesthesia and continuous invasive monitoring in a well-equipped medical center provides the safest setting for delivery. Assisted vaginal delivery may offer a lower risk of death than cesarean section. The nurse, as well as the other members of the multidisciplinary team, should be well versed in the normal physiologic stresses of pregnancy. The fetal and cardiac effects of all medications and interventions must be explored. The almost simultaneous appearance of a new child in one's life with a heightened and immediate awareness of one's own mortality can lead to overwhelming feelings of despair and anxiety. Transition to home life may be difficult. All aspects of the patient's needs from heart to hope, should be addressed.