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Maternal cardiac disease 

Maternal cardiac disease
Chapter:
Maternal cardiac disease
Author(s):

Harini Narayan

DOI:
10.1093/med/9780199673643.003.0004
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date: 30 October 2020

Cardiac disease is a leading cause of maternal mortality and morbidity. Pregnancy carries increased risks for women with congenital heart disease. This chapter addresses the general principles of multidisciplinary management of pregnancies of women with congenital or acquired cardiac diseases including valvular and ischaemic heart disease, aortic dissection, cardiac arrhythmias, hypertrophic cardiomyopathy and the rare, but life threatening peripartum cardiomyopathy. The fact file for each condition outlines aetiopathology, symptomatology, de-novo presentation in pregnancy, impact of cardiac diseases on pregnancy and vice versa. Pre-pregnancy cardiology/obstetric assessment and counselling with risk stratification, review of medications, continued assessment of maternal cardiac status during pregnancy, anaesthetic input, fetal assessments, risk of fetal cardiac disease, and prognosis are discussed. Controversies in anticoagulant regimen for prosthetic heart valves are addressed. Care pathways incorporate guidance regarding appropriate referrals to tertiary centres, integrated management plans for antenatal care, labour, delivery, postnatal contraceptive advice and continued cardiology surveillance.

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