Managing cardiac disease in pregnancy

More women with congenital heart disease now reach their adult reproductive years in good health. It is likely therefore that the number of those who present for care during pregnancy will continue to increase. The physiological changes that normally occur in pregnancy can compromise the conditions of women with heart disease, often leaving them with minimal cardiovascular reserve. There are particularly high risks associated with certain cardiac conditions and pregnancy in these women is contraindicated. Women with congenital heart disease can be physically very ill in pregnancy and most have added emotional requirements. The needs of these women are often complex and diverse with many potential complications. Midwives caring for these patients are consequently challenged to remain not only competent in midwifery but also competent in many aspects of cardiology, together with the need to remain sensitive to the emotional care requirements that accompany these conditions.