Maternal mortality often is assumed to be related to obstetric complications such as bleeding, but recent national data show those assumptions are not accurate. One in four maternal deaths is related to cardiovascular disease or cardiomyopathy.

New findings about the sometimes-hidden cardiac problems of pregnant women and treatment recommendations by the American College of Obstetricians and Gynecologists (ACOG) are reviewed by ACOG Immediate Past President Lisa Hollier, MD, MPH, in the 51st Annual Louis F. Bishop Keynote.

"Part of the importance of having the opportunity to present this lecture is to elevate the understanding and awareness of the tremendous impact that cardiovascular disease and cardiomyopathy have on women," says Hollier, professor of obstetrics and gynecology at Baylor College of Medicine. "It is important that we all remember many of the women who experienced cardiac problems in pregnancy are women who have not previously been identified."

The number of maternal deaths related to cardiovascular disease and cardiomyopathy has been collected during detailed reviews of those deaths, she says. Maternal deaths occur not only during delivery, but after delivery, when symptoms can mimic benign upper respiratory infections, Hollier adds.

"The importance of the contribution of cardiovascular disease and cardiomyopathy is relatively new," she says. "Over the last year as I talked to my colleagues in medicine, I found that many were surprised at how common mortality due to cardiovascular disease and cardiomyopathy was. Emergency physicians also are another group for whom this is relatively newer information. There are cardiologists who are aware of these rates, but I think this is an opportunity to inform the broader community of the important contribution of cardiovascular disease and cardiomyopathy to maternal death."

As the impact of cardiac disease became more clear, ACOG gathered anesthesiologists, cardiologists and emergency physicians to work with OB-GYNs in updating its Practice Bulletin, Pregnancy and Heart Disease. Released in May 2019, the Bulletin includes clear information to help health care providers differentiate normal pregnancy from women for whom evaluation is necessary and women who urgently need consultation, Hollier says. The Bulletin also presents a stepwise strategy for evaluation.

"This helps combine symptoms, patient vital signs, preexisting risk factors and the physical exam findings to recommend a management plan," she says.

Another key is enhanced communication between OB-GYNs, cardiologists and anesthesiologists and the use of a "pregnancy heart team" to develop care plans, including delivery.

"Collaboration between cardiology and obstetrics is critically important," Hollier says. "That relationship is something we need to promote so we can work together to manage these complex patients. [In the keynote] I conclude with recommendations on follow-up care and discuss women who have obstetric complications who need to see cardiologists later in life. That is a big update for us. Women who have pregnancy complications, like preeclampsia, have a significantly increased lifetime risk for cardiovascular disease."

Watch the CardioObstetrics Intensive I Featuring the 51st Annual Louis F. Bishop Keynote, and CardioObstetrics Intensive II at Virtual.ACC.org.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Scientific Session Newspaper 2020, ACC Annual Scientific Session, acc20, Pregnancy, Maternal Mortality, Maternal Death, Gynecology, Obstetrics, Aftercare, Risk Factors, Pre-Eclampsia, Cardiovascular Diseases, Heart Diseases, Cardiomyopathies, Pregnancy Complications

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