title: Cardiac disease in pregnancy.
abstract: Congenital heart disease in pregnancy is increasingly common because of the advances in surgery and medical therapy which have taken place over the last 30 years, which means that more affected women are surviving into the reproductive age. Antenatal counselling needs to be tailored to the specific lesion, with pulmonary hypertension and cyanotic disease presenting a risk of maternal mortality of up to 50%. The use of anticoagulants in women with artificial valves presents a particular challenge, heparin being safer for the baby and warfarin for the mother. Peripartum cardiomyopathy and Marfan's syndrome may be less dangerous than once thought. The risk of congenital heart disease in the fetus is increased, from twice to 20-fold, depending on the nature of the mother's lesion. Care throughout pregnancy and in the puerperium should be multidisciplinary and include cardiologists, obstetricians and midwives with experience of such cases, preferably in a tertiary centre.
authors.affiliation: Department of Obstetrics/Gynaecology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Lupton
authors.forename: Eugene
authors.initials: E
authors.lastname: Oteng-Ntim
authors.forename: Gubby
authors.initials: G
authors.lastname: Ayida
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Steer
mesh_terms: D000925:Anticoagulants; D003376:Counseling; D005260:Female; D006330:Heart Defects, Congenital; D006331:Heart Diseases; D006349:Heart Valve Diseases; D006350:Heart Valve Prosthesis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D010348:Patient Care Team; D011181:Postnatal Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012306:Risk
chemical_list: D000925:Anticoagulants