DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20161278

Cardiac disease in pregnancy: still an arduous conundrum for the obstetrician

Sheeba Marwah, Manjula Sharma, Harsha Shailesh Gaikwad, Ritin Mohindra

Abstract


Cardiac diseases, complicating about 1 percent of all pregnancies, account for significant maternal morbidity and mortality by being the leading cause of obstetrical intensive care unit admissions and of indirect maternal deaths. Of late, there has been observed a changing pattern in heart disease, the etiology having shifted from primarily rheumatic to predominantly congenital (75–82%), with shunt lesions preponderating (20–65%). Counseling and management of women of childbearing age with suspected cardiac disease ought to commence prior to conception; they should be managed by interdisciplinary teams; high risk patients must be treated in specialized facilities, and diagnostic procedures and interventions should be executed by mavens with profound expertise in the cardiovascular diseases and proficiency in treating pregnant women. This article provides a comprehensive review on management of cardiac disease in pregnancy to assist obstetricians in tackling this mystifying medical situation effortlessly, attaining a favorable feto-maternal outcome.


Keywords


Cardiac disease in pregnancy, Management

Full Text:

PDF

References


Simpson LL. Maternal cardiac disease: update for the clinician. Obstet Gynecol. 2012;119:345

The Task Force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC).ESC guidelines. European Heart Journal. 2011:32;3147-97.

Stangl V, Schad J, Gossing G, Borges A, Baumann G, Stangl K. Maternal heart disease and pregnancy outcome: a single-centre experience. Eur J Heart Fail. 2008;10:855-60.

Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease.Circulation.2001;104:515–21.

Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review.JAMA.2000; 283:1183-8.

Cunningham FG, Leveno KJ, Bloom SL, Spong YC, Dashe SJ. Cardiovascular Disorders. William’s Obstetrics. 24th edition. McGraw Hill Education; 2014:973-99.

Robson SC, Dunlop W, Moore M, Hunter S. Combined Doppler and echocardiographic measurement of cardiac output: theory and application in pregnancy. Br J Obstet Gynaecol. 1987;94:1014-27.

Gandhi M, Martin SR. Cardiac disease in pregnancy. Obstetrics and Gynecology clinics. 2015;42(2):315-33.

ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104:647-51.

Savu O, Jurcuţ R, Giusca S, Van MT, Gussi I, Popescu BA, Ginghina C, Rademakers F, Deprest J, Voigt JU. Morphological and functional adaptation of the maternal heart during pregnancy. Circ Cardiovasc Imaging. 2012;5(3):289-97.

Vitarelli A, Capotosto L.Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy. Int J Cardiovasc Imaging. 2011;27:843.

Shellock FG, Crues JV. MR procedures: biologic effects, safety, and patient care.Radiology. 2004;232:635-52.

De Wilde JP, Rivers AW, Price DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol.2005;87:335-53.

Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al. ACR guidance document for safe MR practices. AJR Am J Roentgenol. 2007;188:1447-74.

Van HKH, Kitsis RN, Katz SD, Factor SM. Peripartum versus idiopathic dilated cardiomyopathy in young women- a comparison of clinical, pathologic and prognostic features. Int J Cardiol. 1993;40:57-65.

Seshadri S, Oakeshott P, Nelson-Piercy C, Chappell L. Prepregnancy care. Clinical Review. BMJ. 2012;344:3467.

Clark SL, Hankins GD. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol.2012;119:360.

Jastrow N, Meyer P, Khairy P, Mercier LA, Dore A, Marcotte F. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary Center.Int J Cardiol. 2010;151(2):209-13.

Oron G, Hirsch R, Ben HA, Hod M, Gilboa Y, Davidi O, Bar J. Pregnancy outcome in women with heart disease undergoing induction of labour. BJOG. 2004;111(7):669-75.

ACOG practice bulletin 120, June 2011- Use of Prophylactic Antibiotics in Labor and Delivery

Keizer JL, Zwart JJ, Meerman RH, Harinck BI, Feuth HD, Van RJ. Obstetric intensive care admission: a 12-year review in a tertiary care centre. Eur J Obstet Gynecol Reprod Biol. 2006;128:152-6.

Zeeman GG: Obstetric critical care: a blueprint for improved outcomes. Crit Care Med. 2006;34:208.

WHO Medical eligibility criteria wheel for contraceptive use 2015.

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J.2007; 28:230-68.

Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46:223-30.