Cardiac disease in pregnancy

An increasing number of women with complex cardiac disease are becoming pregnant which brings challenges for cardiologists, obstetricians and anaesthetists. Assessing risk and counselling patients prior to pregnancy is important; however, often women have unplanned pregnancies, or their cardiac condition is not diagnosed until during pregnancy. Normal pregnancy requires the mother to mount profound cardiovascular physiological changes, which can increase the risk of cardiac decompensation in women with underlying cardiac disease. Close monitoring by specialist multidisciplinary teams and detailed planning are essential to reduce both maternal and foetal risk. Changing patient demographics mean that there is an increase in women with complex congenital heart disease who require careful pre-conceptual evaluation and planning for their pregnancies. Another emerging problem is that of an increasing prevalence of atherosclerotic ischaemic heart disease in women of child-bearing years. Various risk stratification classifications are available to aid the clinician and patient alike. Management for most conditions remains close to that of the non-pregnant population, but risks associated with cardiovascular and obstetric drugs need to be borne in mind.