PMM.38 Evaluating the Requirement for a Joint Obstetric/Cardiology Clinic within NHS Tayside

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Abstract

Background

Cardiac disease is the leading cause of maternal death in the UK1 with the RCOG recommending a multidisciplinary approach to cardiac disease in pregnancy.2

Aim

To determine whether there was a demand for a combined cardiology/obstetric clinic within the region.

Methods

A retrospective case-note review of cardiac investigations carried out in pregnant women in NHS Tayside who delivered between 01/01/13 and 30/04/13. Data of those women who had cardiac investigations during pregnancy/puerperium were obtained using clinical portal and case-notes and analysed using Excel.

Results

A total of 1386 women delivered in the time period with thirty-four women requiring cardiac evaluation (incidence 2.5%). The age range was 15–40 years (median 30 years). Twenty-two had echocardiograms, fifteen underwent ambulatory monitoring, and four had an event recorder. Six women had two or more investigations. The gestation at which they were investigated ranged from 6 weeks gestation to 6 days postpartum (median 23 weeks). Indications for investigation were palpitations, breathlessness or chest pain, heart murmur, suspected cardiomyopathy, endocarditis or pericarditis. Most women were managed as outpatients (79%) with the remainder as inpatients (one required admission to CCU). There were no adverse incidents. Outpatient investigations were carried out within acceptable timeframes and cardiologists were easily accessible for advice or to review patients.

Conclusion

A low incidence of women in our obstetric population require cardiac investigations. A multidisciplinary approach to the management of these women was achieved with good communication between specialists without a formal clinic; however this will need to be continually evaluated.

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