Clin Med
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Cardiac disease is the leading cause of maternal mortality in the UK. The major causes of cardiac deaths in pregnancy include cardiomyopathy, myocardial infarction, ischaemic heart disease and dissection of the thoracic aorta. With increasing numbers of migrant women in the UK, rheumatic heart disease in pregnancy has also re-emerged. ⋯ The care of pregnant women with heart disease thus requires a multidisciplinary approach, involving obstetricians, cardiologists and anaesthetists. This allows appropriate surveillance of maternal and fetal wellbeing, as well as planning and documentation of the management of elective and emergency delivery. This review discusses common cardiac conditions encountered in pregnancy and their antenatal and intrapartum management.
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Community-acquired pneumonia (CAP) is one of the most common acute infections requiring admission to hospital. The main causative pathogens of CAP are Streptococcus pneumoniae, influenza A, Mycoplasma pneumoniae and Chlamydophila pneumoniae, and the dominant risk factors are age, smoking and comorbidities. ⋯ In the future, routine use of biomarkers to improve risk stratification and tailor management to individual patients could improve outcomes, and there is some evidence that modulation of CAP-associated inflammation could also be beneficial. Both research into host-microbial interactions in the lung and clinical trials of different management and preventative treatments are urgently needed to combat the increasing morbidity and mortality associated with CAP.