Previous Confidential Enquiries into Maternal Deaths in the UK have highlighted the issue of cardiac disease and shown it to be the most common cause of death amongst pregnant women.
Dr Lorna Swan explains that although most pregnancy and heart disease services focus on women with congenital heart disease that is known about prior to pregnancy, the rise in maternal mortality over the last 30 years has been predominantly related to new cases of previously undetected heart disease. The 2006-2008 Confidential Enquiry into Maternal Deaths showed that the majority of women who died from cardiac disease (79%) had acquired heart disease.
It is therefore vital to detect those women most at risk either before pregnancy or at their initial booking visit. Factors which play a role include obesity, age, family history, diabetes, ethnicity and smoking. This presents a very large challenge to antenatal services and highlights important educational needs for women considering pregnancy and for all involved in their care.
In addition, Dr Swan highlights the issue of Sudden Adult Death Syndrome, which is associated with obesity and left ventricular hypertrophy (LVH), thickening of the muscle of the pumping chambers of the heart. The 2006-2008 Confidential Enquiry into Maternal Deaths revealed that 10 women died of Sudden Adult Death during that period.
Women that need access to specialist care include those with murmurs, unexplained chest pains, previous cardiac surgery and significant arrhythmias, says Dr Swan. There also needs to be the ability for front line staff including midwives and GPs to identify women with risk factors for acquired heart disease.
Dr Swan concludes by saying that better education is needed about these risk factors and that improved pathways need to be developed from pre-conception counselling, through to emergency care and follow up.
“Cardiac disease in pregnancy is on the increase and it can affect women with known cardiac problems but also women with no previous knowledge of cardiac disease,” says Dr Swan.
“One of the concerning trends is the number of sudden cardiac deaths which are still unexplained but may be associated with the rise in obesity.
“We need to look at how we deliver effective screening of seemingly well pregnant women and increase awareness of cardiac disease. Preventative measures such as detecting women with possible risk factors pre-pregnancy and during the antenatal period will help doctors provide the best possible care.”
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