A new set of guidelines will help doctors spot hidden heart disease in pregnant women and new mothers.
The guidelines, part of a recently released toolkit from the Stanford-based California Maternal Quality Care Collaborative, are intended to improve diagnosis and treatment of women whose new or existing heart conditions interact with pregnancy. Heart problems are the leading cause of death in pregnant women and new moms, and such deaths have risen across the United States in recent years.
"Most pregnancies occur in young, healthy women and there is an overlap between signs and symptoms women may experience in a normal pregnancy and those they may experience due to cardiac disease, specifically shortness of breath, fatigue and swelling," the toolkit authors write.
As a result, doctors can mistake warning signs of peripartum cardiomyopathy for harmless pregnancy side effects. A 2016 study found that about half of these cardiac patients were initially misdiagnosed, while a statewide survey of maternal deaths that occurred in California between 2002 and 2006 found that most women who died of heart problems did not have a known cardiac condition before pregnancy, and a quarter of these deaths could have been prevented with faster diagnosis. The California Department of Public Health asked for the new toolkit to try to reduce such deaths in the future.
The toolkit tells doctors what to look for. It identifies "red flag" symptoms of pregnancy-related heart disease, such as shortness of breath; difficulty breathing when lying down; high resting heart rate, blood pressure, or breathing rate; and decreased blood oxygen saturation. The guidelines also describe diagnostic tests to order if a woman shows signs of heart disease, and give advice for women in specific, vulnerable populations. Stanford cardiologist Abha Khandelwal, MD, and nurse-researcher Julie Arafeh wrote the guidelines for women with adult congenital heart disease, and Stanford research sociologist Christine Morton, PhD, is a co-author of the section describing cardiovascular health disparities in African-American women.
Importantly, the toolkit also encourages all pregnant women to receive screening for cardiovascular disease, and provides a detailed algorithm to help doctors decide what combinations of symptoms, vital-sign abnormalities, cardiac risk factors and warning signs on a physical exam should prompt them to refer a patient for follow-up with a cardiologist.
The California Maternal Quality Care Collaborative is offering a webinar on January 19 for clinicians who want to learn more about using the toolkit. Online pre-registration is required for the free webinar.
Previously: How California reversed the national trend of rising maternal mortality, New obstetric hemorrhage tool kit released today and Cardiac arrest in pregnancy: New consensus statement addresses CPR for expectant moms
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