Mortalité maternelle par pathologies cardiovasculaires. Résultats de l'enquête nationale française confidentielle sur la mortalité maternelle, 2010-2012

Between 2010 and 2012, 29 maternal deaths were caused by cardiovascular disease, i.e. an overall maternal mortality ratio of 1.2 per 100,000 live births. Deaths occurred in pre-existing heart disease (n = 19), peripartum cardiomyopathy (n = 5), or arterial rupture (n = 5). Care was considered non-optimal in three of five patients with congenital heart disease and due to delayed management by specialized teams. Pregnant patients with heart disease should be considered to be at high risk of mortality or severe cardiovascular complications and therefore reoriented as soon as possible to a perinatal center with the expertise of these pathologies. A delay in the management related to incorrect diagnosis was reported in three patients with peripartum cardiomyopathy. Peripartum cardiomyopathy should be considered in patients with severe left ventricular failure on cardiac ultrasound and particularly in women without pre-existing cardiac disease. A diagnosis of myocardial infarction was never suspected despite suggestive clinical and paraclinical criteria. A suggestive symptomatology of myocardial infarction reported in any pregnant woman and during the immediate postpartum period, and regardless of cardiovascular risk factors, should be promptly investigated and managed.