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Guidance addresses cardiac contributors to maternal death.

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

The algorithm is called the California Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum Toolkit. It was developed 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.

The guidance also calls for all pregnant and postpartum women with known or suspected cardiovascular disease (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]:e320-56).

Twenty-seven recommendations and conclusions relating to screening, diagnosis, and management of CVD for women during the prepregnancy period through the postpartum period are in the guidance.

ACOG president Lisa Hollier, MD, convened the task force that developed this guidance to address cardiac contributers to maternal mortality.

"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," Dr. Hollier, a professor of obstetrics and gynecology at Baylor College of Medicine, Houston, said during a press briefing at the ACOG annual clinical and scientific meeting.

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 briefing. She also implored her colleagues to "start using this guidance immediately and prevent more women from dying from cardiovascular complications of pregnancy." Dr. Hollier reported having no relevant disclosures.



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

Caption: Dr. Hollier further discusses ACOG's new guidance in an video interview on

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Title Annotation:OBSTETRICS
Author:Worcester, Sharon
Publication:Family Practice News
Date:May 1, 2019
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