Pregnancy and Contraception

The clinical content of preconception care: women with chronic medical conditions

This article reviews the medical conditions that are associated with adverse pregnancy outcomes for women and their offspring. We also present the degree to which specific preconception interventions and treatments can impact the effects of the condition on birth outcomes. Because avoiding, delaying, or achieving optimal timing of a pregnancy is often an important component of the preconception care of women with medical conditions, contraceptive considerations particular to the medical conditions are also presented.

Assessment and management of cardiac disease in pregnancy

Approximately 1% of pregnancies are affected by congenital or acquired cardiac disease. The obstetric care provider requires an understanding of the expected cardiorespiratory adaptations to pregnancy in order to anticipate when and how the cardiac patient may decompensate. Although the majority of women with cardiac disease in pregnancy can expect a positive outcome, women should be evaluated for predictors of poor perinatal outcome to aid in determining the appropriate location for and surveillance in labour. Women affected with congenital heart disease require counselling about the risk of recurrence in their offspring. The discussion of contraceptive needs for the woman with cardiac disease is critical in the appropriate planning of her family.

Cardiac disease and pregnancy

The pregnant state imposes a supraphysiologic strain on the pregnant woman's cardiac performance through complex biochemical, electric, and physiologic changes affecting the blood volume, myocardial contractility, and resistance of the vascular bed. In the presence of underlying heart disease, these changes can compromise the woman's hemodynamic balance, her life, and that of her unborn child. Cardiac pathology represents a heterogeneous group of disorders, each with its own hemodynamic, genetic, obstetric, and social implications. Physicians caring for these women should actively address the issue of reproduction. Ideally, pregnancy should be planned to occur after optimization of cardiac performance by medical or surgical means. Once pregnancy is achieved, the concerted effort of a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, nursing, social, and other services provides the best opportunity to carry the pregnancy to a successful outcome.

Pregnancy and heart disease: a review

About one per cent of all pregnancies are affected by maternal heart disease, which may have significant influence on the maternal and foetal outcome. In this context rheumatic heart disease is declining and congenital heart disease is becoming the dominant category. Our experience of pregnancy in the new groups of patients created by paediatric heart surgery is scant and a continuous update is required.

Congenital heart disease and pregnancy

In Europe and North America, a dramatic fall in the incidence of rheumatic fever and rheumatic heart disease has coincided with advances in medical and surgical management of congenital heart disease and has resulted in a shift in the relative incidence of these two categories of cardiac disorders in women of child-bearing age. This review deals with pregnancy and congenital heart disease--unoperated and operated. Central to this topic is the intricate interplay between maternal circulatory and respiratory physiology and maternal congenital heart disease, and the effects of this interplay upon the fetus which is exposed to risks that threaten its intrauterine viability and to risks that subsequently express themselves as developmental defects or transmitted congenital malformations of the heart or circulation.