Cardiac disease complicates 1%-4% of pregnancies globally, with cardiogenic shock being the most extreme manifestation requiring early recognition and potentially mechanical circulatory support.
This narrative review discusses recent developments in the classification of cardiogenic shock and how they may be adapted to improve outcomes in pregnant women.
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
Greer et al. (Wed,) conducted a review in Cardiogenic shock in pregnancy. Management of cardiogenic shock was evaluated. Cardiac disease complicates 1%-4% of pregnancies globally, with cardiogenic shock being the most extreme manifestation requiring early recognition and potentially mechanical circulatory support.