Saving Mothers' Lives: - Public Health Agency for Northern Ireland

9 Cardiac disease
Catherine Nelson-Piercy
Cardiac disease: Specifi c recommendations
As recommended in other Chapters of this Report, pregnant immigrant women require a complete medical
examination, including cardiovascular examination, by an appropriately trained doctor at booking.
Maternity health care professionals must remember the possibility of rheumatic heart disease in
immigrant women and there should be a low threshold for investigation if any symptoms develop.
Women at higher risk of developing cardiac disease in pregnancy, i.e. the obese, those who smoke or
who have existing hypertension and/or diabetes, a family history of heart disease and those over the
age of 35, should be appropriately counselled of these risks pre-conception and particularly prior to
receiving assisted reproductive technology (ART) or other infertility treatment.
Clinicians should have a low threshold for further investigating pregnant or recently delivered women,
especially those with any of the above risk factors, with severe chest pain, chest pain that radiates
to the neck, jaw or back, chest pain associated with other features such as agitation, vomiting or
breathlessness, tachycardia, tachypnoea or orthopnea. Appropriate investigations include an electrocardiogram
(ECG), a chest x-ray (CXR), cardiac enzymes (Troponin), echocardiogram and CT
pulmonary angiography.
If a clinician is not confi dent or competent to interpret an ECG, he/she should discuss the woman’s
case and show her ECG to someone who is.
Summary of key fi ndings for 2003-05
In this triennium cardiac disease was the commonest cause of maternal death overall. A total of 48 women
who died from heart disease associated with, or aggravated by, pregnancy were reported to the Enquiry
in 2003–05. All but one of these cases were fully assessed and these deaths are discussed further in this
Chapter. These are classifi ed as Indirect maternal deaths. This compares with 44 deaths in 2000-2002
and 35 deaths in 1997–99, as shown in Table 9.1. This Table shows a clear rise in mortality from cardiac
causes since the late 1980s, but no further rise in 2003-05. The maternal mortality rate for cardiac disease
was 2.27 per 100,000 maternities in 2003-05.
In addition, lessons arising from 34 other women known to the Enquiry who died from cardiac disease
later after delivery are discussed and considered here although they are counted as Late deaths in
Chapter 14. Future Reports will continue to consider all maternal deaths from cardiac disease which occur
during pregnancy or within six weeks of birth, as well as those Late cardiac deaths which arise directly or
indirectly from the woman having been pregnant, such as deaths attributed to peripartum cardiomyopathy.
Three other maternal deaths to which cardiac disease contributed are counted and considered in other
Chapters. One woman died from pulmonary embolus although aortic dissection was a contributing feature,
another from liver disease with pulmonary hypertension and the third from amniotic fl uid embolism.
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