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ACOG guidance addresses cardiac contributors to maternal mortality



All women should be assessed for cardiovascular disease in the antepartum and postpartum periods using a specific toolkit algorithm, according to new comprehensive guidance from the American College of Obstetricians and Gynecologists.

The toolkit algorithm is called the California Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum Toolkit. It was developed by the Cardiovascular Disease in Pregnancy Postpartum Task Force to serve as a resource for obstetrics, primary care and emergency medicine providers who provide prenatal care or interact with women during the postpartum period. It incldues an overview of clinical assessment and comprehensive management strategies for cardiovascular disease based on risk factors and presenting symptoms.

The guidance also calls for all pregnant and postpartum women with known or suspected CVD to undergo further evaluation by a “Pregnancy Heart Team that includes a cardiologist and maternal–fetal medicine subspecialist, or both, and other subspecialists as necessary.” The guidance was issued in Practice Bulletin 212, Pregnancy and Heart Disease, which is published in the May edition of Obstetrics & Gynecology (Obstet Gynecol. 2019 May;133[5]:e320-e356).

In all, 27 specific recommendations and conclusions relating to screening, diagnosis, and management of CVD for women during the prepregnancy period through the postpartum period are included in the guidance.

ACOG president Lisa Hollier, MD, convened the task force that developed this guidance to address cardiac contributors to maternal mortality, she said during a press briefing at the ACOG annual clinical and scientific meeting.

“When I began my presidency a year ago, my goal was to bring together a multidisciplinary group of clinicians ... to create clinical guidance that would make a difference in the lives of women," said Dr. Hollier, who is also a professor of obstetrics and gynecology at Baylor College of Medicine, Houston.

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Part of her presidential initiative was centered on eliminating preventable maternal death, and this guidance has the potential to make strides toward that goal, she said. When it comes to CVD in pregnancy, “there is so much we can do to prevent negative outcomes and ensure that moms go home with their babies and are around to see them grow up,” she noted.

CVD is the leading cause of death in pregnant women and women in the postpartum period, accounting for 26.5% of U.S. pregnancy-related deaths.

“It’s critical that we as physicians and health care professionals develop expertise in recognizing the signs and symptoms so that we can save women’s lives,” she said in the press breifing. Dr. Hollier also implored her colleagues to “start using this guidance immediately and prevent more women from dying from cardiovascular complications of pregnancy.”

In this video interview, Dr. Hollier further explains the need for the guidance and its potential for improving maternal mortality rates.

Dr. Hollier reported having no relevant disclosures.

SOURCE: Hollier L et al., Obstet Gynecol. 2019 May;133[5]:e320-56.

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