Cardiopathies et grossesse

Despite improvement, pregnancy in women with heart disease is still associated with significant maternal and foetal morbidity and mortality. The last two confidential enquiries into maternal death in the UK indicate that heart disease is the joint most common cause of maternal death in this country. Management of heart disease during pregnancy raises two different problems: full cardiac assessment and follow-up by experienced teams of cardiac disease, nowadays mostly congenital, diagnosed before pregnancy, which may deteriorate with pregnancy and labour-induced physiological changes; diagnosis and treatment of de novo cardiac disease occurring during pregnancy and puerperium, among which ischemic disease, aortic dissection, peripartum cardiomyopathy (PPCM) and amniotic fluid embolism-induced ventricular dysfunction incidences appear to increase. We discuss in this review pregnancy and labour-induced hemodynamic changes, diagnosis and assessment of cardiac condition and management of acute cardiovascular disease in pregnant woman, which is necessarily multidisciplinary and integrates both maternal and foetal conditions.