TITLE:
Heart and Lung Disorders Complicating Pregnancy and the Puerperium: Pitfalls in Practice & Lessons Learned
AUTHORS:
James Nello Martin Jr., James Martin Tucker
KEYWORDS:
Cardiopulmonary, Cardiovascular, Maternal Morbidity & Mortality, Pregnancy & Postpartum Complications
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.4,
April
15,
2021
ABSTRACT: Objective: To review a case series of 12 women with unexpected heart and lung
disorders that occurred during pregnancy and the puerperium, describing for
teaching purposes the pitfalls in practice and the lessons learned from this
experience. Materials & Methods: We reviewed case files of women
with medical and/or hypertensive complications of pregnancy that were evaluated for medicolegal defense purposes by the
first author between 1986-2015. Twelve
women in these case files experienced unexpected cardiovascular and/or
cardiopulmonary complications late in pregnancy or early in the puerperium. For
each case, the pertinent medical record information was extracted. Important concepts as lessons learned are summarized
and referenced for teaching purposes. Results: Five women had
undetected preexisting heart disease which acutely deteriorated during the
third trimester, four women developed postpartum heart failure related to
pregnancy and delivery, and three women suffered
an intrapartum cardiac arrest; none survived. Their case presentations
illustrate the importance of obstetric health care professionals being alert to
the signs/symptoms of developing cardiopulmonary disease late in pregnancy and
following delivery so that timely evaluation and intervention can be
accomplished to potentially avoid morbidity and mortality. Diagnostic
categories include peripartum heart failure, high-risk chronic hypertension,
superimposed preeclampsia, amniotic fluid embolism, pulmonary embolism and
Raynaud’s with occult pulmonary hypertension. Conclusion: These cases
illustrate the diversity of ways that cardiovascular disease can suddenly
complicate pregnancy and the early postpartum period. A major part of any
effort to enhance safer motherhood is a heightened awareness by obstetric
specialists to consider the possibility of heart disease in all maternity
patients so that appropriate consultation and collaboration with other
specialists might help avoid major maternal morbidity or mortality.