Heart Diseases in Pregnancy: A Narrative Review

The field of “heart diseases in pregnancy” has expanded significantly over the last few decades, driven by shifting maternal demographics. Heart diseases in pregnancy includes acquired cardiac diseases, as well as uncorrected, corrected, and palliated congenital heart diseases. Physiological hemodynamic changes associated with pregnancy often adversely affect both the underlying cardiac condition and the developing fetus. The heart diseases in pregnancy are the primary cause of non-obstetric mortality. Consequently, management of pregnant women with acquired or congenital heart diseases has evolved toward structured preconception counselling, systematic antepartum risk stratification, and coordinated care by a multidisciplinary pregnancy heart team. Many of these patients require treatment with anticoagulants or antiplatelets due to their cardiac conditions or specific obstetric indications. All the anticoagulants used during pregnancy have critical anesthetic implications and must be discontinued well in advance of a planned neuraxial block. While a normal course of pregnancy, labor, and the postpartum period is possible for the majority of parturients, a substantial number of cases remain highly complicated. In some instances, pregnancy carries a very high risk of maternal mortality and pregnancy is medically discouraged. For patients in this high-risk category who present before the 10 th week of gestation, termination of pregnancy is generally recommended. In other cases, active management of cardiac disease, sometimes requiring anesthesia, is necessary. This review focusses on the principles of anesthetic management for elective and emergency surgery or for a procedure in catheterization laboratory based on lesion-specific hemodynamic goals, with an added aim to preserve uteroplacental blood flow.