A pregnant patient reports worsening shortness of breath, ankle swelling, and fatigue. Another had preeclampsia five years ago, but that history has never informed her cardiovascular risk assessment. A third has congenital heart disease and is considering pregnancy without preconception counseling.
Cardio-obstetrics helps clinicians identify and care for patients like these before, during, and after pregnancy. The multidisciplinary approach brings together cardiology, obstetrics, maternal-fetal medicine and other specialists to assess risk, evaluate symptoms, plan deliveries and support long-term cardiovascular health. Pregnancy complications can also reveal risks that persist well beyond delivery.
Refer before pregnancy
Pregnancy increases blood volume, heart rate and cardiac output. These changes can reveal previously unrecognized heart disease or worsen an existing condition. A preconception consultation gives the care team time to assess maternal and fetal risks, review medications, optimize cardiac health, and develop a plan for pregnancy and delivery.
Consider referral for patients with:
- Cardiomyopathy, heart failure or a history of peripartum cardiomyopathy
- Moderate or severe valvular disease
- Congenital heart disease
- Pulmonary hypertension
- Aortic dilation or aortopathy
- Coronary artery disease, a prior heart attack, or spontaneous coronary artery dissection
- Clinically significant arrhythmias
- Difficult-to-control hypertension
- A cardiovascular complication in a previous pregnancy
- Cardiovascular medications that may need to be changed before conception
The goal is to define each patient’s risk and establish a coordinated care plan before pregnancy begins.
Evaluate concerning symptoms during pregnancy
Fatigue, mild shortness of breath, swelling, and occasional palpitations can occur in an uncomplicated pregnancy. Symptoms that worsen, limit daily activity, or occur in a patient with cardiovascular risk factors warrant closer attention.
Prompt cardiovascular evaluation is indicated for:
- Shortness of breath at rest, difficulty breathing while lying flat, or waking at night short of breath
- Fainting or unexplained near-fainting
- Persistent rapid heart rate
- New or unexplained chest pain
- A new concerning heart murmur or signs of fluid in the lungs
- Preeclampsia accompanied by heart or breathing symptoms
Progressive symptoms should not be dismissed as a routine part of pregnancy.
Continue care after delivery
Cardiovascular risk does not end at delivery. Fluid shifts in the early postpartum period can worsen heart failure, blood pressure control, or arrhythmias. Patients with significant heart disease or hypertensive disorders of pregnancy need a clear follow-up plan after discharge.
Postpartum care should also address future risk. Preeclampsia and other adverse pregnancy outcomes can signal a greater likelihood of cardiovascular disease later in life. Documenting pregnancy history and sharing it with the patient’s primary care clinician supports blood pressure monitoring, appropriate testing, and preventive counseling.
Cardio-obstetrics care at Northside
Northside Hospital Heart Institute’s Cardio-Obstetrics Program provides care before, during, and after pregnancy. Its multidisciplinary team supports cardiovascular evaluation, management, delivery planning and postpartum follow-up. Northside offers cardio-obstetrics clinics at its Atlanta, Cherokee, Forsyth and Gwinnett locations. Northside Hospital Atlanta is a Level IV maternal care facility.
Early referral gives the team time to assess risk and coordinate care. Clinicians should consider consultation when symptoms are concerning, heart disease is significant, or the safest path through pregnancy is unclear.
For referrals and consultations, call 404-845-8200.
LEARN MORE ABOUT NORTHSIDE HOSPITAL HEART INSTITUTE.
Reference: American College of Cardiology
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