Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · May 2014
ReviewPregnancy in inherited and acquired cardiomyopathies.
Cardiomyopathy encompasses a wide spectrum of heart muscle disease, which can have an impact on the patient's ability to sustain the increased cardiac workload of pregnancy. Pregnancy can also unmask previously unknown cardiomyopathy. The outcome for both mother and baby is often related to the patient's functional class prior to pregnancy, and a multidisciplinary approach to managing this challenging group of patients is pivotal.
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In women with valvular heart disease, pregnancy-associated cardiovascular changes can contribute to maternal, foetal and neonatal complications. Ideally, a woman with valvular heart disease should receive preconception assessment and counselling from a cardiologist with expertise in pregnancy. ⋯ Pregnancy in women with high-risk lesions, such as severe aortic stenosis, severe mitral stenosis and those with mechanical valves, requires careful planning and coordination of antenatal care by a multidisciplinary team. The purpose of this overview is to describe the expected haemodynamic changes in pregnancy, review pregnancy risks for women with valvular heart disease and discuss strategies for management.
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Cardiac arrest in pregnancy is a rare event in routine obstetric practice, but is increasing in frequency. Resuscitation of cardiac arrest is more complex for pregnant women because of a number of factors unique to pregnancy: the altered physiologic state induced by pregnancy; the requirement to consider both maternal and fetal issues during resuscitation; and the consequent possibility of perimortem caesarean section during resuscitation. ⋯ Although many research questions remain in this area, recent consensus has been reached on appropriate resuscitation of a pregnant woman. Centres offering care for birthing women need to be aware of the changing demographics and resuscitation guidelines in this important area, and implement measures to ensure dependable and optimal team responses to maternal cardiac arrest.
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Best Pract Res Clin Obstet Gynaecol · May 2014
ReviewObstetric anaesthesia and peripartum management.
Anaesthetists play a key role in the management of parturients with cardiac disease. Pregnant women with cardiac disease should be seen antenatally in a high-risk obstetric anaesthesia clinic, and a comprehensive management plan formulated. ⋯ No evidence exists to definitively support either regional or general anaesthesia for caesarean section, and much depends on the urgency of the procedure and the severity of disease. Women with the most severe forms of cardiac disease should be managed by a consultant anaesthetic team, with experience of both cardiac and obstetric anaesthesia.