A Mother and Child Reunion
"Few subjects can be conceived calculated to attract...more serious thought and attention on the part of obstetricians, than the bearing of organic disease of the heart upon the condition of the pregnant, parturient, and lying-in woman....and yet scarcely a subject that borders on the mutual region occupied by the obstetric and the pure physician seems to have received less study from either the one or the other. The reason, no doubt, is partly due to the cramping effects of a too rigid specialism....But as every woman has not only a uterus and ovaries, but also a liver, heart, lungs, kidneys, etc...." 1
Angus Macdonald, 1878
The Bearings of Chronic Disease of the Heart upon Pregnancy, Parturition, and Childbed
Pioneering studies and clinical experience long ago identified the major risk factors for adverse pregnancy outcomes in women with congenital heart disease (CHD): functional status, pulmonary vascular disease, systemic ventricular dysfunction and cyanosis.1-4 Additional insights have been provided by subsequent observational studies, population-based research and reports of pregnancy in new and evolving populations of women with CHD. These studies have validated and expanded upon earlier observations and provided critical quantitative tools to stratify risk.5-7 They have not, however, fundamentally informed our understanding of why a subset of these women and their offspring suffer specific adverse outcomes. There is an increasingly well-described problem with no clear path towards a solution.
- maternal heart disease
- pregnancy and postpartum
- Doppler ultrasound
- adult congenital heart disease
- congenital heart disease
- Received October 21, 2013.
- Accepted October 24, 2013.