CMACE 2008 has shown that the overall rate of mortality from cardiac disease has tripled over the last two decades being, the largest cause of indirect maternal death; mainly due to acquired heart disease. With the current increase in older mothers, obesity, immigration and survival of babies operated on for congenital heart disease, the need to identify women at risk of heart disease and to plan their careful management is crucial.
Early identification of risk factors include hypertension, pre-eclampsia, diabetes, smoking, obesity and hyperlipidaemia and a multidisciplinary management improves maternal and foetal outcomes.
General principles include a MDT approach with obstetrician, physician and regular monitoring.
A 5-year retrospective survey of 31 women with cardiac disease was carried out in a Joint clinic. (3200 deliveries annually).
Data included demographics, type of heart disease, medical, drug history, pregnancy management, delivery place, outcomes.
19 primigravida,14 multipara; all except one were all Caucasian.
The most frequent reasons for referral were congenital heart disease or surgery for it, (n = 13) valve disease (n = 9) and arrhythmias (n = 8). Also, chemotherapy induced cardiomyopathy, pericarditis and neurocardiogenic syncope.
All women were booked into the clinic by 12 weeks. 24 (73%) had ECG, 25 (76%) echocardiography. 10 women had foetal echocardiogram in pregnancy (all normal). 79% women had cardiology referral, 34% anaesthetic referral.
29 (93%) pregnancies were delivered locally while 4 delivered in a tertiary unit. 19 women delivered vaginally, 7 had emergency CS while 4 planned CS. 1 had a PPH and 1 admission to NNU.
Maternal cardiac disease management in a joint clinic shows good outcomes.