Cardiac conditions in pregnancy and the role of midwives: A discussion paper

Abstract

Aim This paper provides an overview of the two broad categories of cardiac conditions observed in pregnancy (congenital and acquired). It also identifies the midwives' role in the childbirth continuum and includes assessment, track and trigger systems and management during labour and delivery. Design Discussion paper. Methods Data were collected by reviewing international evidence and by searching computerized databases. Results Research has identified that women with associated risk factors of a cardiac condition who delay pregnancy have an increased risk of experiencing cardiovascular complications in pregnancy with poorer outcomes. The Three Ps in a Pod clinical initiative in the United Kingdom highlights working as a team in multidisciplinary programmes to improve mothers' care and save lives. Midwives play a key role during pregnancy and need to be appraised in relation to cardiovascular disease observed in pregnancy, its potential risks and anticipated problems and within the continuum of care.

Adherence to clinical practice guidelines for South Australian pregnant women with cardiac conditions between 2003 and 2013

“…Two pivotal recommendations are the completion of preconception counselling and a comprehensive initial antenatal assessment. Therefore, it is vital to ensure that all health practitioners have the skills, training and sufficient time to complete the initial assessment [3].…”

“…The epidemiology of cardiac disease in pregnancy varies internationally with 0.2-4% estimates; however, it remains under-researched in Australia as reported by Australian Maternity Outcome Surveillance System (AMOSS) [1,2]. Cardiac disease in pregnancy encompasses a broad spectrum of conditions that include congenital heart disease (CHD), structural and aortic disease, cardiomyopathies, rhythm disorders and pregnancy acquired conditions such as ischemic heart disease (IHD) [3,4]. Cardiac disease is associated with increased rates of morbidity and hospitalisation during pregnancy, with one in four women requiring admission, and is now one of the leading causes of maternal mortality [4][5][6].…”

Duration of Lactation and Maternal Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

“…For women, pregnancy provides an opportune time to evaluate risk [82]. Cardiac risk factors (e.g., hypertension, smoking, obesity, diabetes, pre-eclampsia) are routinely assessed during antenatal care, and midwives and obstetricians are often the first health care personnel to recognize women with elevated cardiac risk profiles [83]. Despite midwifery care is associated with reduced maternal mortality and morbidity and improved public health outcome [84], midwives and obstetricians have rarely been considered a part of the health care service, which focuses on women's health beyond the postpartum period.…”

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

“…The two broad categories of cardiac conditions in pregnancy are preexistent heart disorders and pregnancy-acquired cardiac conditions [10,11]. Congenital heart disease (CHD) is the predominant diagnosis of all cardiac lesions in developed countries (75% to 82%).…”