Heart Disease in Pregnancy

The second edition, like the first one, is intended to provide practical guidance
to clinicians looking after patients with heart disease, or who may be at risk of
cardiac problems, in pregnancy and the puerperium. These will be hospital
physicians and cardiologists, obstetricians, general practitioners and specialist
nurses who provide direct care as well as the anaesthetists responsible for making
delivery safe and the geneticists who answer the many questions posed by
couples with a personal or family history of heart disease.
All of our contributors were chosen for the wealth of their personal clinical
experience of pregnancy in a particular area of cardiovascular-respiratory disease.
While modern cardiology has a broader evidence basis from clinical trials
than any other speciality such evidence is singularly lacking for pregnancy in
which practice is based at best on cohort studies, otherwise it relies on literature
reviews, anecdote and personal experience. Clinical trials are sparse even in the
area of hypertension and this will always be so because numbers are inevitably
small and neither clinicians nor patients feel comfortable about randomisation
into trials at this time. National registries may be a potential solution for the
future.
Antenatal cardiac clinics and the practice of shared care with local cardiologists
and general practitioners has expanded since the first edition, helped especially
by the creation of regional centres for grown up congenital heart disease
and combined clinics. Regional centres mean longer journeys but shared care
reduces their frequency and brings patients access to local help when they need
it. We hope you will find what you need in these pages.