Acquired heart disease and pregnancy
- Carol A Waksmonski, MD
Carol A Waksmonski, MD
- Professor of Medicine
- Columbia University Medical Center
- Anita LaSala, MD
Anita LaSala, MD
- Assistant Professor of Obstetrics-Gynecology
- Columbia University Medical Center
- Michael R Foley, MD
Michael R Foley, MD
- University of Arizona College of Medicine - Phoenix
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Although cardiac disease complicates a small percentage of all pregnancies in developed countries (eg, only 1 to 4 percent of pregnancies in the United States), maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality (figure 1). Care of high-risk patients requires a team approach including a maternal-fetal medicine specialist, cardiologist, and obstetrical anesthesiologist.
In the past, rheumatic heart disease was the most common form of cardiac disease in pregnant women; it still predominates in developing countries and in immigrant populations in the United States. Congenital heart disease is now the most common form of heart disease complicating pregnancy in the United States, in part because advances in the treatment of congenital heart disease have made it possible for more affected children to reach adulthood and attempt pregnancy. (See "Pregnancy in women with congenital heart disease: General principles" and "Pregnancy and Marfan syndrome".)
In addition, many women are postponing childbearing until the fourth and fifth decades of life [1,2]; with advancing maternal age, underlying medical conditions such as hypertension, diabetes, and hypercholesterolemia become more common and increase the incidence of acquired heart disease complicating pregnancy.
This topic will discuss the risk assessment and management of pregnant women with acquired heart disease. Valvular heart disease and congenital heart disease in pregnant women are discussed separately. (See "Pregnancy and valve disease" and "Pregnancy in women with congenital heart disease: General principles".)
PHYSIOLOGY OF NORMAL PREGNANCY
Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes begin early in pregnancy (within the first five to eight weeks), reach their peak during the late second trimester, and then remain relatively constant until delivery . Knowledge of these cardiovascular adaptations is required to correctly interpret hemodynamic and cardiovascular tests in the gravida, to predict the effects of pregnancy on the woman with underlying cardiac disease, and to understand how the fetus will be affected by maternal cardiac disorders. (See "Maternal adaptations to pregnancy: Cardiovascular and hemodynamic changes".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PHYSIOLOGY OF NORMAL PREGNANCY
- Antepartum hemodynamic changes
- Physical examination
- Electrocardiographic changes
- Hemodynamic changes during labor and delivery
- Minimizing hemodynamic effects
- ASSESSING RISK
- Predictors of cardiac events
- Brain natriuretic peptide
- CORONARY ARTERY DISEASE
- MYOCARDIAL INFARCTION
- HEART TRANSPLANT RECIPIENTS
- MANAGEMENT OF LABOR AND DELIVERY
- Hemodynamic monitoring
- Mode and timing of delivery
- Fetal monitoring
- Antibiotic prophylaxis
- Postpartum care
- SUMMARY AND RECOMMENDATIONS