BLOCK 11: Pregnancy and Heart Disease (Cardio-Obstetrics)
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Learning Objectives By Lesson
1-Background & Risk Stratification in Pregnancy
  • Identify causes for the increased incidence of heart disease in pregnant women
  • Describe the main physiologic changes that occur in pregnancy
  • Describe the main physiologic changes that occur in labor and delivery
  • Identify indications for Caesarian section during pregnancy
  • Describe the goals of pregnancy risk assessment
  • Identify important discussion topics during preconception counseling
  • Identify important considerations in oprtimizing cardiac status for pregnancy
  • Describe how to estimate the cardiac risk for pregnancy
  • Identify potential maternal and fetal/neonatal adverse outcomes
  • Describe how to assess cardiac risk for pregnancy
  • Become familiar with cardiac risk estimators for pregnancy
  • Identify women who should be advised against pregnancy
  • Identify importnat perinatal obstetric complications
  • Identify risk factors for perinatal obstetric complications
2-Valvular Disease in Pregnancy
  • Identify forms of valvular disease requiring close attention during pregnancy
  • Describe the general approach to valve evaluation in women with clinical deterioration during pregnancy
  • Identify the mode of labor and delivery in women with underlying valve disease
  • Describe the physiologic and potential clinical consequences that might occur during pregnancy in the setting underlying mitral stenosis
  • Identify potential fetal and neonatal complications assocaited mitral stenosis
  • Describe the treatment approach for mitral stenosis in the context of pregnancy, including mitral stenosis refractory to medical therapies
  • Idenitfy important underlying causes for mitral regurgitation to consider in pregnancy
  • Describe the physiologic and potential clinical consequences that might occur during pregnancy in the setting underlying mitral regurgitation
  • Idenitfy important underlying causes for aortic stenosis to consider in pregnancy
  • Identify potential fetal and neonatal complications assocaited aortic stenosis
  • Describe the management of symptomatic aortic stenosis during pregnancy
  • Idenitfy important underlying causes for aortic regurgitation to consider in pregnancy
  • Describe how underlying left ventricular function can affect the aortic regurgitation in pregnancy
  • Idenitfy important underlying causes for pulmonary regurgitation to consider in pregnancy
  • Describe the affect of underlying pulmonary stenosis or tricuspid regurgitation in a woman during pregnancy
  • Describe how prosthetic valves impact care and outcomes during pregnancy
  • Describe how to manage anticoagulation for prosthetic heart valves during pregnancy
  • Describe how to manage anticoagulation during pregnancy in the setting of prosthetic valve thrombosis
  • Identify materal and fetal/neonatal complications associated with prosthetic heart valves during pregnancy
3-Congenital Heart Disease & Pulmonary Hypertension in Pregnancy
  • Identify high risk congenital heart disease conditions associated with pregnancy
  • Describe the blood flow in Fontan circulation
  • Identify important pregnancy complications assocaited with Fontan circulation
  • Identify women with Fontan circulation who should be adviced against pregnancy
  • Describe the general management approach for pregnant women with Fontan circulation
  • Identify cases in which a systemic right ventricle might be present
  • Describe the blood flow after an atrial switch procedure
  • Describe pregnancy related outcomes in patients with an atrial switch procedure and how they differ from congenitally corrected transposition of the great arteries
  • Identify women with a systemic right ventricle who should be adviced against pregnancy
  • Describe the general management approach for pregnant women with a systemic right ventricle
  • Identify cardiac complications associated with underlying uncorrected cyanotic heart disease
  • Identify a important predictor of fetal outcome with pregnant women underlying uncorrected cyanotic heart disease and how that affects their management during pregnancy
  • Describe the general management approach for pregnant women with underlying uncorrected cyanotic heart disease
  • Describe the general prognosis for pregnant women with underlying pulmonary hypertension
  • Describe the WHO classfication for pulmonary hypertension
  • Describe how to counsel woman with established pulmonary hypertension considering pregnancy
  • Describe the general management approach for pregnant women with pulmonary hypertension
4-Aortopathy in Pregnancy
  • Review the basic anatomy of the aorta
  • Identify the etiologies associated with aortic disease in pregnant women
  • Identify important genetic disorders associated with aortopathy
  • Identify pre-existing factors associated with an increased risk of aortic dissection during pregnancy
  • Describe the aortopathy generally associated with Marfan syndrome, including high risk features in pregnancy
  • Describe important topics to counsel women with Marfan syndrome regarding pregnancy
  • Describe when preconception prophylactic surgery should be considered in women with Marfan syndrome
  • Describe the management of women with Marfan syndrome with aortic dilatation during pregnancy
  • Describe clinical features associated with Turner syndrome
  • Describe why it is important to take into account body surface area when making aortic measurements in patients with Turner syndrome
  • Identify factors associated with an increased risk of aortic dissection in patients with Turner syndrome
  • Describe the general management approach of aortopathy in patients with Turner syndrome during pregnancy
  • Describe the general management approach of aortopathy in patients with bicuspid aortic valve during pregnancy
  • Describe how often the aorta should be monitored in women with aortopathy during pregnancy
  • Describe how labor and delivery should be manageed in pregnant women with aortopathy, including when to consider Caesarean section
5-Dilated & Peripartum Cardiomyopathy in Pregnancy
  • Define peripartum cardiomyopathy
  • Identify etiologies and risk factors associated with peripartum cardiomyopathy
  • Describe the prognosis and potential complications associated with peripartum cardiomyopathy
  • Identify factors influencing the risk of death in patients with peripartum cardiomyopathy
  • Identify predictors of poor left ventricular function recovery following peripartum cardiomyopathy
  • Describe the prognosis of patients with peripartum cardiomyopathy in subsequent pregnancies
  • Describe the treatment strategy for patients with peripartum cardiomyopathy
  • Describe the role of anticoagulation in peripartum cardiomyopathy
  • Describe the management of sudden cardiac arrest in peripartum cardiomyopathy
  • Describe the role of mechanical circulatory support in peripartum cardiomyopathy
  • Describe how to counsel women with peripartum cardiomyopathy about breastfeeding
  • Describe the general evaluation and management strategy for pre-existing dilated cardiomyopathy during pregnancy
  • Identify predictors of adverse maternal cardiac events in women with pre-existing dilated cardiomyopathy
  • Describe the role of anticoagulation for women with pre-existing dilated cardiomyopathy during pregnancy
Contributors: Nandan Anavekar, MBBCh; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Anthony Kashou, MD
Last updated: January 2023.
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