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Cardio-Obstetrics: Team-Based Care to Improve Maternal Outcomes
State-wide maternal mortality review committees have shed light on cardiovascular-related maternal deaths. In Illinois, Briller et al3 found that of 140 maternal deaths from 2002 to 2011, more than a fifth (22%) were related to cardiovascular disease. The most common causes were related to acquired cardiovascular disease (97.1%), including cardiomyopathy (27.9%), stroke (22.9%), hypertensive disorders (12.9%), arrhythmias (10.7%), and coronary disease (9.3%). Relatively fewer deaths were related to congenital heart disease (2.9%). In California, nearly a quarter (24.9%) of the pregnancy-related deaths from 2002 to 2006 were attributed to cardiovascular disease, and two-thirds of these deaths were related to cardiomyopathy.
Maternal deaths were deemed to be potentially preventable in approximately a quarter of the cases reviewed by these 2 state committees. Preventability was assessed by whether specific and feasible actions could have been implemented to lead to a nonfatal outcome, such as evaluating the cause of severe shortness of breath in a postpartum woman. The complex problems facing high-risk obstetric populations require a team-based approach including cardiology, maternal-fetal medicine, obstetrics, anesthesiology, and nursing.
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