Cardiovascular disease in pregnancy

Cardiac disease is the leading cause of maternal death in the UK with a growing proportion of women being affected by ischaemic heart disease. In this paper we describe the changes in cardiac physiology encountered in pregnancy that may unmask pre-existing cardiac disease and the effects of individual cardiac diseases in this context. Key cardiac investigations and their safety, application and interpretation in pregnancy are discussed. We outline the main cardiac pathology that can affect women during this period and provide a summary of the available evidence to guide management. This can be informed by the Toronto risk score which highlights four key factors linked to maternal outcomes: Prior cardiac events, baseline symptoms or cyanosis, left heart obstruction or left ventricular ejection fraction <40%. As cardiac disease increases; the importance of pre-pregnancy diagnosis, effective pre-pregnancy counselling and contraception are essential to safely manage planned pregnancies in the presence of significant cardiac morbidity. Aspects of obstetric care that require adjustment in the presence of cardiac disease are highlighted.