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Pregnancy and heart disease
Pregnancy in high risk cardiac conditions
  1. Jolien W Roos-Hesselink1,
  2. Johannes J Duvekot2,
  3. Sara A Thorne3
  1. 1
    Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
  2. 2
    Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, Netherlands
  3. 3
    Department of Cardiology, The Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
  1. Professor J W Roos-Hesselink, Department of Cardiology, Room Ba 308, Erasmus MC, Thoraxcenter, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; j.roos{at}erasmusmc.nl

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Heart disease is present in 0.5–1% of all pregnant women and is the biggest killer of pregnant women in the developed world (fig 1). Surprisingly, there have been no signs of decline in this incidence over the past two decades (fig 2). In the UK, all maternal deaths (during pregnancy and within the first post partum year) are recorded and examined in detail every 3 years. Of the maternal cardiac deaths reported for the 2003–5 triennium, more than half were due to coronary artery disease, puerperal cardiomyopathy and aortic dissection (table 1).1 As in previous triennial reports, substandard care continues to be an important factor, and contributed to the woman’s death in more than a third of cases.

Figure 1

Overall death rates per million maternities UK, 2003–05. AFE, amniotic fluid embolism; CNS, central nervous system; VTE, venous thromboembolism. Adapted with permission from Saving mothers’ lives: reviewing maternal deaths to make motherhood safer. 7th report of the Confidential Enquiries into Maternal Deaths in the UK. London: Royal College of Obstetrics and Gynaecology, 2007.

Figure 2

Increase in maternal death from cardiac disease in the UK (deaths/1 000 000 maternities).

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Table 1 Major causes of maternal death from cardiac disease; UK 2003–2005. Adapted from: Saving mothers’ lives: reviewing maternal deaths to make motherhood safer. 7th report of the Confidential Enquiries into Maternal Deaths in the UK. London: Royal College of Obstetrics and Gynaecology, 2007.

These conditions often present acutely and catastrophically in women with no known pre-existing disease. Rapid recognition of the acute presentation and appropriate management will improve their chances of survival. In addition, identifying risk factors for these conditions should flag up at risk patients for targeted ante- and post-natal care. Modifiable risk factors such as obesity and smoking appear particularly important for this group of women and are a growing public health problem. In addition, social deprivation and immigrant status are significant risk factors for maternal deaths of all causes, including heart disease, underscoring the need to improve access to health care for these vulnerable groups.

ACUTE CORONARY SYNDROMES AND ISCHAEMIC HEART DISEASE

Death from ischaemic heart disease

Maternal deaths from acute coronary syndromes (ACS) and ischaemic …

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