Cardiac disease in pregnancy

Cardiac disease has become the single most important cause of maternal death in the United Kingdom and other developed countries over the last 30 years, mostly due to acquired heart disease secondary to women having their pregnancies later in life. The main causes of mortality are myocardial infarction/ischaemic heart disease (one-third) and cardiomyopathy (a further third). The remaining deaths are mostly associated with rheumatic heart disease, congenital heart disease, and pulmonary hypertension (about 5–10% each). Pregnancy represents a challenge to women with impaired cardiac function because of the cardiovascular changes associated with the increase in blood supply to the uterus and placenta. Preconception counselling is vital and should cover the risk of mortality, morbidity, and the increased rate of preterm birth and fetal growth restriction in affected women. Antenatal and intrapartum care needs to be planned by a multidisciplinary team and delivered by staff with appropriate expertise.