Cardiovascular disease in pregnancy

Cardiac disease continues to be an important cause of maternal morbidity and mortality and is now the leading cause of maternal deaths in the United Kingdom. This is largely because of extensive haemodynamic changes which occur during pregnancy, namely the increase in blood volume, fluctuations in cardiac output, fall in systemic vascular resistance and 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, prior history of cardiac events or arrhythmia and the degree of systolic dysfunction. Conditions where pregnancy should be include Eisenmenger's syndrome, pulmonary hypertension, complex cyanotic congenital heart disease, Marfan 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 foetal outcomes.