819: Care of the Pregnant Cardiac Patient – the Importance of a Multidisciplinary Approach

Cardiac disease is a significant contributor to severe maternal morbidity (SMM). The objective of our study was to assess obstetric and cardiac outcomes among pregnant women with cardiac disease managed by a multidisciplinary care team. This retrospective cohort study was conducted in a single-center over a 6-year period (2012-2018). At our center, all pregnant patients with congenital and acquired cardiac disease are cared for by a multidisciplinary team of perinatologists, cardiologists, anesthesiologists, and nurses. Monthly in-person meetings are held to coordinate the care of pregnant patients and develop detailed delivery and postpartum care plans including intrapartum monitoring, labor analgesia, and postpartum location. Peripartum SMM at the time of delivery was defined based on CDC criteria. Among 136 pregnancies in 117 women, 41 (35%) had arrhythmias, of which 26% were defibrillator or pacemaker dependent. Forty-five women (38%) had undergone open cardiac surgery with 44% of those receiving anticoagulation. Ten women (7%) developed pre-eclampsia, 10 (7%) had PPROM, and 36 (26 %) had preterm birth. Fifty-four women (39%) were induced, 26% of those for worsening cardiac function. Twenty women (14%) experienced an intrapartum cardiac or thrombotic event including one woman with pulmonary edema, three with arrhythmia, and two with cardiomyopathy/heart failure. Seventy-seven women (57%) were delivered vaginally. Of the 58 cesarean sections, 26 (45%) were scheduled per interdisciplinary cardiac care team planning. All unscheduled cesarean sections were performed for obstetric or neonatal indications; none were for worsening intrapartum cardiac function. Twenty women (15%) developed a postpartum cardiac event (pulmonary edema, arrhythmia, cardiomyopathy, acute heart failure, or stroke), and 8 women (6%) were readmitted within 6 weeks. Sixteen women (12%) experienced SMM at the time of delivery with a variable annual SMM rate, ranging from 0-20% (Table 1). Peripartum severe maternal morbidity and obstetric complications among women with cardiac disease are higher than the rate described in the general population. Given the increased morbidity, such pregnancies mandate multidisciplinary comprehensive pregnancy care and planning.