Management of cardiac disease in pregnancy

Pregnancy makes a significant demand on the cardiovascular system. Therefore, it follows that women with cardiovascular compromise due to cardiac disease need specialist input and careful management pre-, peri-, and post-partum. In the latest CEMACH report, cardiac disease was the most common cause of indirect maternal deaths and the most common cause of death overall. In particular, during 2003–5, there was an increase in deaths due to myocardial infarction, thoracic aortic dissection, and rheumatic mitral stenosis. The causes of maternal cardiac deaths in 2003–5 are summarized in Table 1. Of particular relevance to anaesthesia and intensive care is that the majority of pregnant women who die of heart disease have not been identified as being ‘at risk’ before labour. Maternal cardiac disease has the potential to remain undiagnosed during pregnancy, but presentation often occurs after 20 weeks gestation and frequently at the time of delivery or immediately post-partum. This is most likely to happen in women who have avoided, or not presented for, antenatal care. An appreciation of the issues involved in the care of the parturient with cardiac disease and an awareness of the signs and symptoms is therefore important.