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34 Utilisation of a combined obstetric-cardiology clinic in a uk tertiary cardiology centre
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  1. Shue Jun Cheng1,
  2. Khin Lan2,
  3. Omar Rasool2,
  4. Pamela Brown2,
  5. Shreya Thapa2,
  6. Deepika Meneni2
  1. 1South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough, MDB TS4 3BW, United Kingdom
  2. 2South Tees Hospitals NHS Foundation Trust

Abstract

Introduction Cardiac disease remains the leading cause of indirect maternal death in the UK, of which mortality rates from cardiac disease has remained unchanged at approximately 2 per 100,00 maternities over the last two decades. Cardiac disease also accounts for 12% of all-cause mortality in the postpartum period. The 2018 ESC Taskforce guidelines has since introduced the concept of the pregnancy heart team to further optimize and tailor the management of women at moderate to high cardiovascular risk based on their modified WHO (mWHO) risk classification (Table 1). We evaluated how this service was utilised in a tertiary hospital in its first year of inception.

Methods All patients that were referred to the combined obstetric-cardiology clinic between November 2020 and November 2021 were included. Data including demographics, underlying cardiac diagnosis, mWHO risk classification, cardiac investigation findings (if performed) and whether pre-conception counselling or delivery recommendations were made during these consultations were collected from clinic letters and from the local electronic database.Results73 patients were referred to the combined obstetrics and cardiology clinic, of which 66 were seen, 4 did not attend and 3 did not have a documented clinic letter. Of the 66 seen, the mean gestational age at first presentation was 22.6 weeks. 15 (22.7%) had an underlying inherited cardiac condition, 13 (19.7%) had arrhythmia, 7 (10.6%) had valve disease, 8 (12.1%) had cardiomyopathy and 23 (34.8%) had other cardiac diagnosis (aortic disease, simple shunts and palpitations/ syncope with no documented arrhythmia) (Figure 1). Among these patients, 22 (33.3%) had mWHO I, 35 (53%) had mWHO II, 7 (10.6%) had mWHO III and 2 (3%) had mWHO IV (Figure 2). Only 6 of the 66 patients had pre-counselling advice documented, all had delivery recommendations made following the consultation.

Conclusion A combined obstetric cardiology clinic was an unmet need at this tertiary hospital and uptake has been good in the first year since its inception. Future work will however be required to promote preconception counselling as well as to develop formal guidelines and referral pathways to further optimize utilisation of this pregnancy heart team clinic.

Conflict of Interest None

  • Cardiac disease
  • Pregnancy Counselling
  • Pregnancy Heart Team

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