Citation

Steer P. Womens Health Med. 2005; 2(2): 18-21.

Copyright

(Copyright © 2005, Elsevier Publishing)

DOI

10.1383/wohm.2.2.18.63059

PMID

unavailable

Abstract

Heart disease is a relatively common complication of pregnancy, with an incidence in the UK of about 1%. Heart disease is now second only to suicide as the leading cause of maternal mortality, with 44 deaths in 2000-2002. The increase in cardiac death rates since the mid-1980s (from about 5 to 20 deaths per million maternities) is due to acquired disease (up from 4 deaths in 1985-1987 to 27 in 2000-2002). This emphasizes the importance of careful evaluation of the cardiovascular system at first antenatal check in all pregnancies. Pregnancy is a challenge to women with heart disease because of the 50% increase in plasma volume and six-fold increase in the risk of thrombosis. Antenatal checks need to be frequent (weekly from 24 weeks), with careful assessment of heart rate and rhythm, with auscultation to detect the early sign of endocarditis or pulmonary oedema. If the mother has congenital heart disease, the incidence of congenital heart disease in the baby will be increased from the background rate of 0.8% to 2.5%-50%, depending on the nature of the mother's lesion. All these mothers should therefore be offered fetal cardiac scanning in the middle trimester. Delivery should be as low stress as possible, and the majority of women will be offered a trial of vaginal delivery with a low-dose slow incremental top-up epidural and elective instrumental delivery of the baby. Caesarean section poses an additional risk, and should be carried out only for specific obstetrical maternal indications. © 2005 Elsevier Ltd. All rights reserved.

Language: en

Keywords

maternal death; pregnancy; endocarditis; cardiac; fetal cardiac scanning; pulmonary oedema