Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE 2 ( March-April, 2024 ) > List of Articles

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Cardio-obstetrics: A Potential Global Development in the Reduction of Maternal Mortality

Sharvi R Chavan

Keywords : Adverse maternal outcomes, Cardio-obstetrics, Cardiovascular disease in pregnancy, Cardiovascular monitoring, Maternal health

Citation Information : Chavan SR. Cardio-obstetrics: A Potential Global Development in the Reduction of Maternal Mortality. J South Asian Feder Obs Gynae 2024; 16 (2):156-160.

DOI: 10.5005/jp-journals-10006-2393

License: CC BY-NC 4.0

Published Online: 23-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Maternal mortality remains a global health concern, particularly in areas with limited access to quality healthcare. An innovative strategy known as cardio-obstetrics is gaining popularity because it has the potential to lower maternal mortality by emphasizing the complex interactions between cardiovascular health and obstetric outcomes. An overview of the developing area of cardio-obstetrics and its contribution to reducing maternal mortality globally is given in this abstract. The utilization of cutting-edge diagnostic technologies, risk assessment techniques, and individualized treatment strategies based on each patient's particular medical history are essential to the effectiveness of cardio-obstetric therapies. The field of cardio-obstetrics is aware of the crucial connection between poor fetal and maternal outcomes and pre-existing cardiovascular problems. It emphasizes how crucial it is for obstetricians and cardiologists to work together to provide complete treatment to expectant mothers with cardiovascular risk factors. By detecting and controlling these risks early in pregnancy, cardio-obstetrics seeks to prevent problems including thrombo-embolic events, heart failure, and hypertensive disorders, which are significant causes of maternal death. Cardio-obstetrics has a tremendous deal of potential to reduce maternal mortality, but to achieve fair worldwide adoption, problems such unequal access to healthcare, lack of infrastructure, and the need for continued professional development must be addressed. Cardio-obstetrics is a progressive and all-encompassing approach to reducing maternal mortality. Recognizing the complex relationship between cardiovascular health and maternal outcomes allows healthcare systems to collaborate to implement strategies that save lives and improve maternal well-being around the world. This abstract highlights the importance of cardio-obstetrics as a developing discipline and its potential to make significant contributions to achieving the Sustainable Development Goals for maternal health.


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  1. Significant Decline in Maternal Mortality in India [cited 2023 Nov 6]. Available from: http://pib.gov.in/FeaturesDeatils.aspx? NoteId=151238.
  2. Konar H, Chaudhuri S. Pregnancy complicated by maternal heart disease: a review of 281 women. J Obstet Gynaecol India 2012;62(3):301–306. DOI: 10.1007/s13224-012-0220-2.
  3. Sharma G, Ying W, Silversides CK. The importance of cardiovascular risk assessment and pregnancy heart team in the management of cardiovascular disease in pregnancy. Cardiol Clin 2021;39(1):7–19. DOI: 10.1016/j.ccl.2020.09.002.
  4. Ananth CV, Duzyj CM, Yadava S, et al. Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension 2019;74(5):1089–1095. DOI: 10.1161/hypertensionaha.119.12968.
  5. Magun E, DeFilippis EM, Noble S, et al. Cardiovascular care for pregnant women with cardiovascular disease. J Am Coll Cardiol 2020;76(18):2102–2113. DOI: 10.1016/j.jacc.2020.08.071.
  6. Silversides CK, Grewal J, et al. Pregnancy outcomes in women with heart disease. J Am Coll Cardiol 2018;71(21):2419–2430. DOI: 10.1016/j.jacc.2018.02.076.
  7. Thakkar A, Hailu T, Blumenthal RS, et al. Cardio-obstetrics: The next frontier in cardiovascular disease prevention. Curr Atheroscler Rep 2022;24(7):493–507. DOI: 10.1007/s11883-022-01026-6.
  8. Davis MB, Walsh MN. Cardio-obstetrics: Team-based care to improve maternal outcomes. Circ Cardiovasc Qual Outcomes 2019;12(2). DOI: 10.1161/circoutcomes.118.005417.
  9. Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American heart association. Circulation 2020;141(23). e884–e903. DOI: 10.1161/cir.0000000000000772.
  10. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014;130(12):1003–1008. DOI: 10.1161/circulationaha.114.009029.
  11. Chapman AB, Abraham WT, Zamudio S, et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int 1998;54(6):2056–2063. DOI: 10.1046/j.1523-1755.1998.00217.x.
  12. Bader RA, Bader ME, Rose DJ, et al. Hemodynamics at rest and during exercise in normal pregnancy as studied by cardiac catheterization 12. J Clin Invest 1955;34(10):1524–1536. DOI: 10.1172/jci103205.
  13. Mahendru AA, Everett TR, Wilkinson IB, et al. A longitudinal study of maternal cardiovascular function from preconception to the postpartum period. J Hypertens 2014;32(4):849–856. DOI: 10.1097/hjh.0000000000000090.
  14. Clapp JF III, Capeless E. Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol 1997;80(11):1469–1473. DOI: 10.1016/s0002-9149(97)00738-8.
  15. Conrad KP. Emerging role of relaxin in the maternal adaptations to normal pregnancy: Implications for preeclampsia. Semin Nephrol 2011;31(1):15–32. DOI: 10.1016/j.semnephrol.2010.10.003.
  16. Fisher C, MacLean M, Morecroft I, et al. Is the pregnancy hormone relaxin also a vasodilator peptide secreted by the heart? Circulation 2002;106(3):292–295. DOI: 10.1161/01.cir.0000025630.05387.45.
  17. Robson SC, Dunlop W, Moore M, et al. Haemodynamic changes during the puerperium: A Doppler and M-mode echocardiographic study. BJOG 1987;94(11):1028–1039. DOI: 10.1111/j.1471-0528.1987.tb02286.x.
  18. ACOG Practice Bulletin No. 212: Pregnancy and heart disease. Obstet Gynecol 2019;133(5):e320–356. DOI: 10.1097/aog.0000000000003243.
  19. Chambers ME, De Zoysa MY, Hameed AB. Screening for cardiovascular disease in pregnancy: Is there a need? J Cardiovasc Dev Dis 2022;9(3):89. DOI: 10.3390/jcdd9030089.
  20. Thompson JL, Kuklina EV, Bateman BT, et al. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 2015;126(2):346–354. DOI: 10.1097/aog.0000000000000973.
  21. Drenthen W, Boersma E, Balci A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010;31(17):2124–2132. DOI: 10.1093/eurheartj/ehq200.
  22. European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011;32(24):3147–3197. DOI: 10.1093/eurheartj/ehr218.
  23. Mann S, Hollier LM, McKay K, et al. What we can do about maternal mortality — and how to do it quickly. N Engl J Med 2018;379(18): 1689–1691. DOI: 10.1056/NEJMp1810649.
  24. D'Alton ME, Bonanno CA, Berkowitz RL, et al. Putting the “M” back in maternal–fetal medicine. Am J Obstet Gynecol 2013;208(6):442–448. DOI: 10.1016/j.ajog.2012.11.041.
  25. Davis MB, Arendt K, Bello NA, et al. Team-based care of women with cardiovascular disease from pre-conception through pregnancy and postpartum. J Am Coll Cardiol 2021;77(14):1763–1777. DOI: 10.1016/j.jacc.2021.02.033.
  26. Easter SR, Rouse CE, Duarte V, et al. Planned vaginal delivery and cardiovascular morbidity in pregnant women with heart disease. Am J Obstet Gynecol 2020;222(1):77.e1–77.e11. DOI: 10.1016/j.ajog.2019.07.019.
  27. Ruys TPE, Roos-Hesselink JW, Pijuan-Domènech A, et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart 2015;101(7):530–536. DOI: 10.1136/heartjnl-2014-306497.
  28. Levels of maternal care: Obstetric care consensus no, 9. Obstet Gynecol 2019;134(2):e41–55. DOI: 10.1097/aog.0000000000003383.
  29. Mehta LS, Sharma G, Creanga AA, et al. Call to action: Maternal health and saving mothers: A policy statement from the American Heart Association. Circulation 2021;144(15). e251–e269. DOI: 10.1161/cir.0000000000001000.
  30. Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ [Internet] 2007;176(4): 455–460. DOI: 10.1503/cmaj.060870.
  31. Shah LM, Varma B, Nasir K, et al. Reducing disparities in adverse pregnancy outcomes in the United States. Am Heart J 2021;242: 92–102. DOI: 10.1016/j.ahj.2021.08.019.
  32. Parikh NI, Gonzalez JM, Anderson CAM, et al. Adverse pregnancy outcomes and cardiovascular disease risk: Unique opportunities for cardiovascular disease prevention in women: A scientific statement from the American heart association. Circulation 2021;143(18). DOI: 10.1161/cir.0000000000000961.
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