Cardiovascular disease in pregnancy

Heart disease continues to be an important cause of maternal morbidity and mortality. This is largely because of the extensive haemodynamic changes that occur during pregnancy, namely the increase in blood volume, fluctuations in cardiac output, fall in systemic vascular resistance and the hypercoagulable state. High-risk periods include the end of the second trimester, during labour and the immediate postpartum period. Prognosis depends on the specific cardiac condition, the patient's functional class, presence of cyanosis, history of cardiac events or arrhythmia and the degree of systolic dysfunction. Pregnancy is contraindicated in women with Eisenmenger's syndrome, pulmonary hypertension, complex cyanotic congenital heart disease, Marfan's syndrome with aortic root dilatation, and those with severe left ventricular dysfunction. Women with heart disease should be thoroughly evaluated and counselled before and during pregnancy. Multidisciplinary care is essential for successful maternal and fetal outcomes.