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      Cardiac Disease in Pregnancy

      At the annual Royal College of Obstetricians and Gynaecologists (RCOG) World Congress held at Liverpool recently Dr Lorna Swan presented a paper on the growing toll of cardiac disease in pregnancy.

      Dr Swan explained 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 had 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.

      She said it was therefore vital to detect those women most at risk either before pregnancy or at their initial booking visit. Factors which played a role include obesity, age, family history, diabetes, ethnicity and smoking. This presented a very large challenge to antenatal services and highlighted important educational needs for women considering pregnancy and for all involved in their care.

      In addition, Dr Swan highlighted the issue of Sudden Adult Death Syndrome, which is associated with obesity and left ventricular hypertrophy (LVH). The 2006-2008 Confidential Enquiry into Maternal Deaths revealed that 10 women died of Sudden Adult Death during that period.

      Women who need access to specialist care include those with murmurs, unexplained chest pains, previous cardiac surgery and significant arrhythmias. It was also necessary for front line staff including midwives and GPs to have the ability to identify women with risk factors for acquired heart disease.

      Dr Swan concluded that better education was 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,”

      “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.

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