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Cardiogenic shock in pregnancy
Orene Y O Greer1,2, Rathai Anandanadesan3,4, Nishel M Shah1,2
1Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
Insights
Cardiac disease affects 1-4% of pregnancies, with cardiogenic shock (CS) posing a severe risk. Early recognition and management, including mechanical circulatory support (MCS), are crucial for improving outcomes in pregnant women with heart conditions.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Critical Care Medicine
Background:
- Cardiac disease complicates 1%-4% of pregnancies worldwide, particularly in low and middle-income countries (LMICs).
- Rising maternal age, obesity, and comorbidities like pre-eclampsia contribute to acquired cardiovascular disease in pregnancy.
- Increased survival rates for congenital heart disease (CHD) mean more women with CHD are becoming pregnant.
Purpose of the Study:
- To review recent advancements in the classification of cardiogenic shock (CS).
- To explore adaptations of CS classification for improved outcomes in pregnant women.
- To highlight the importance of early recognition and management of cardiac disease during pregnancy.
Main Methods:
- Narrative review of recent developments in cardiogenic shock classification.
- Analysis of how CS classifications can be applied to pregnant populations.
- Discussion of management strategies including mechanical circulatory support (MCS).
Main Results:
- Cardiogenic shock (CS) in pregnancy is associated with significant mortality and morbidity.
- Effective management hinges on early recognition and intervention for reversible causes.
- Individualized care plans and adherence to guidelines have improved clinical outcomes.
Conclusions:
- Adapting current CS classifications may enhance the management of pregnant women at risk.
- Prompt diagnosis and timely intervention are critical for mitigating the risks of CS in pregnancy.
- Further research into tailored CS management strategies for pregnant individuals is warranted.
Abstract:
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
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