Cardiac disease in pregnancy

Abstract

Cardiac disease is a significant cause of maternal mortality. In the UK in the last maternal mortality report, it was the leading cause of indirect maternal deaths (2.39 deaths per 100,000 maternities). The overall rate of maternal mortality from cardiac disease has significantly increased over the last three decades, with this increase being mostly attributable to deaths from ischaemic heart disease, myocardial infarction and peripartum cardiomyopathy. Conditions such as pulmonary hypertension, rheumatic heart disease and congenital cardiac lesions also significantly contribute to the mortality figures. With the current increase in age of mothers, increasing rate of maternal obesity and improved survival of children with congenital heart disease, more mothers will require careful cardiovascular assessment and monitoring of their pregnancies. Many women with cardiac conditions will aim to manage their peripartum care in a specialist centre; however, in an emergency they may present to any delivery suite in any hospital. This means it is essential for all obstetric anaesthetists to have a good understanding of different cardiac conditions and how the physiological changes of pregnancy may affect cardiac function.