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Pre-conceptual counselling in cardiology patients: still work to do and still missed opportunities. A comparison between 2015 and 2019 in women with cardiac disease attending combined obstetric cardiology clinics. Should the European Guidelines change anything?

Published online by Cambridge University Press:  25 May 2021

Chethan R. Kasargod Prabhakar*
Affiliation:
Queen Elizabeth Hospital, Birmingham, UK
Daisy Pamment
Affiliation:
University of Birmingham Medical School, Birmingham, UK
Peter J. Thompson
Affiliation:
Birmingham Women’s Hospital, Birmingham, UK
Hsu Chong
Affiliation:
The Rosie Maternity Hospital, Cambridge, UK
Sara A. Thorne
Affiliation:
Toronto General Hospital, Toronto, ON, Canada
Caroline Fox
Affiliation:
Birmingham Women’s Hospital, Birmingham, UK
Katie Morris
Affiliation:
Birmingham Women’s, Birmingham, UK
Lucy H. Hudsmith
Affiliation:
Queen Elizabeth Hospital, Birmingham, UK
*
Author for correspondence: Chethan R. Kasargod Prabhakar Queen Elizabeth Hospital Birmingham, Birmingham, B15 2GW. E-mail: kasargod.chethan@gmail.com

Abstract

Women with underlying cardiac conditions have an increased risk of adverse pregnancy outcomes. Counselling reproductive age women with heart disease is important to assist them in deciding whether to pursue pregnancy, to ensure their best cardiovascular status prior to pregnancy, and that they understand the risks of pregnancy for them and baby. This also provides an opportunity to explore management strategies to reduce risks. For this growing cohort of women, there is a great need for pre-conceptual counselling.

This retrospective comparative audit assessed new referrals and pre-conceptual counselling of women attending a joint obstetric–cardiology clinic at a tertiary maternity centre in a 12-month period of 2015–2016 compared with 2018–2019. This reflected the timing of the introduction of a multidisciplinary meeting prior to clinics and assessed the impact on referrals with the introduction of the European Society of Cardiology guidelines.

Data were reviewed from 56 and 67 patients in respective audit periods. Patient’s risk was stratified using modified World Health Organization classification.

Less than 50% of women with pre-existing cardiac conditions had received pre-conceptual counselling, although half of them had risks clearly documented. The majority of patients had a recent electrocardiograph and echocardiogram performed prior to counselling, and there was a modest improvement in the number of appropriate functional tests performed between time points. One-third of patients in both cohorts were taking cardiac medications during pregnancy.

There was a significant increase in the number of pregnant women with cardiac disease and in complexity according to modified World Health Organization risk classification. While there have been improvements, it is clear that further work to improve availability and documentation of pre-pregnancy counselling is needed.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Pre-conceptual counselling in cardiology patients: still work to do and still missed opportunities. A comparison between 2015 and 2019 in women with cardiac disease attending combined obstetric cardiology clinics. Should the European Guidelines change anything?
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