The pearls for optimal intrapartum care in women with cardiac disease

Abstract

Cardiac disease during pregnancy is one of the leading causes of maternal mortality and morbidity in both the UK and the USA. Labour, delivery, and the initial postpartum phase are characterised by significant haemodynamic alterations that play a significant role in the clinical deterioration observed in women with heart disease. Heart failure, arrhythmia, and myocardial ischaemia can occur in women with high-risk cardiac lesions during labour. The cardio-obstetric multidisciplinary team, after risk stratification, should establish an individualised cardiac care plan that incorporates patients’ preferences. This care plan should address the location, mode, timing of delivery, monitoring, analgesia, and anaesthetic options for operative intervention, uterotonics that may be administered, emergency contact numbers for relevant personnel along with appropriate postpartum care. High-risk patients need to be delivered in tertiary units. Clear haemodynamic objectives should be established along with a postpartum contraception plan with information cascaded to community midwifery teams and primary care providers to ensure surveillance and continuity of care. Co-ordinated multidisciplinary care can enhance preparedness for obstetric and cardiac emergencies, thereby decreasing morbidity and mortality associated with heart disease in pregnancy during childbirth.