Cardio-obstetrics: Improving care for pregnant patients with heart disease
April 26, 2022
In April 2022, the American Heart Association published results from a survey that found that cardiologists, fellows, and cardiovascular team members want more training in cardio-obstetrics – specialized care for pregnant patients with heart conditions.
However, the survey showed that 76% of respondents have no access to a dedicated cardio-obstetrics team, and only 12% of fellows (doctors receiving advanced training in a specialty) had formalized cardio-obstetrics training.
While not every cardiologist sees pregnant patients, understanding how pregnancy and cardiovascular health intersect is increasingly important. Certain heart conditions, such as gestational diabetes and preeclampsia (severely high blood pressure), develop only during pregnancy or the postpartum period.
Complications such as high blood pressure, heart attack, and heart failure are among the leading cause of maternal death during and after pregnancy. Approximately 1 in 16 women age 20 and older have coronary heart disease, and the rate of heart attacks among patients under 40 is on the rise in the U.S.
Deepening our knowledge of heart disease in pregnancy will help us provide the best care to our pregnant patients and their growing families.
UT Southwestern is one of a handful of hospitals in North Texas to offer comprehensive cardio-obstetric care and provider training. We are a main referral center for community Ob/Gyns and cardiologists. We hold regular cardio-obstetrics team meetings, where specialists from cardiology, maternal fetal medicine, cardiac and obstetric anesthesia meet to determine safe, effective care plans for patients whose needs cross between our areas of expertise.
Together, our maternal-fetal medicine (MFM) doctors and cardiovascular specialists keep each other up to date on the latest patient safety guidelines and give our pregnant patients with heart conditions the best care possible.
How our cardio-obstetrics conference works
Our multidisciplinary team of providers includes:
- Cardiologists with an interest in obstetrics or who are seeing pregnant patients
- Adult congenital cardiologists, who take care of patients who’ve had heart conditions all their lives
- MFM specialists, who manage complex and high-risk pregnancies
- Cardiac and obstetric anesthesiologists
- Fellows in cardiology and MFM
UT Southwestern is staffed 24/7 with all these providers, and our conferences help us all understand the nuances of each expectant mother’s needs.
Conference discussions typically focus on the needs of patients in their third trimester. We start preparing for the patients’ labor and delivery, and discussing whether the patient:
- Can safely deliver vaginally if she chooses
- Will need a planned cesarean (C-section) delivery
- Might need a blood transfusion during or after delivery
- Might need specific types of anesthesia, such as an epidural
- Will need medication adjustments or a procedure before or after delivery
Pre-pregnancy planning is another area of focus – we discuss guidelines and recommendations for patients with complex heart conditions who aren’t pregnant yet but would like to be. We devote part of our conversation to defining best practices for managing specific conditions. Ideally, patients with heart disease will seek preconception counseling to discuss risks and benefits of pregnancy and ensure she has appropriate follow-up and care during her pregnancy.
Related reading: New mom survives SCAD heart attack, hole in her heart
The future of cardio-obstetrics
The need for cardio-obstetric care is increasing. Our multidisciplinary team allows for referrals between cardiology and MFM to be seamless, getting patients into our clinics as quickly as possible for preventive cardiology or cardio-obstetric care. Our conferences have made this process even smoother and increased our collaboration.
Though cardio-obstetric programs are beginning to form around the country, many hospitals do not have synchronicity in managing complex pregnancies. Young women with heart disease should seek pregnancy care from a team of providers who are on the same page about their cardio-obstetric needs, from preconception through postpartum.
And, as with any health concern, every patient should feel empowered to ask questions about their care. Our collaborative cardio-obstetric team is uniquely prepared to address your concerns and plan for even the most complex pregnancies.
To visit with an Ob/Gyn or cardiologist about your risk of heart disease during pregnancy, call 214-645-8300 or request an appointment online.
