Abstract
Background and Objectives: Management of cardiovascular disease (CVD) during pregnancy is challenging and usually requires eminence-based decisions due to limited strong-evidence data in this field. The purpose of our study was to compare the attitudes of anaesthesiologists, cardiologists, and gynaecologists towards the diagnosis and treatment of potentially life-threatening CVDs during pregnancy. Materials and Methods: A cross-sectional, questionnaire-based study was performed among 111 doctors (55 anaesthesiologists, 36 cardiologists, 20 gynaecologists). Personal opinions on the recommendations (n = 19) regarding rare, potentially life-threatening CVDs during pregnancy were recorded using a five-item Likert scale. Results: Opinions regarding eight statements (42%) varied substantially between specialties (p < 0.05). The most distinctive differences between physicians concerned the following recommendations: “thrombolysis should only be used in pulmonary embolism with cardiogenic shock” (agree: 52.7% of anaesthesiologists, 80.4% of cardiologists, 25.0% of gynaecologists; p < 0.001); “women with the antiphospholipid syndrome should restart treatment with vitamin K antagonists from the second trimester of pregnancy” (agree: 12.7% of anaesthesiologists, 69.4% of cardiologists, 20.0% of gynaecologists; p < 0.001); “women with symptomatic pulmonary hypertension should have a Swan–Ganz catheter inserted for labour” (agree: 20.0% of anaesthesiologists, 11.1% of cardiologists, 55.0% of gynaecologists; p = 0.001). Conclusions: Physicians’ opinions regarding diagnostics and treatment of CVDs in pregnancy remain controversial. A multidisciplinary approach is recommended to ensure the safety and effectiveness of management in these unique medical conditions.
Highlights
Pregnancy is a physiologic dynamic process associated with significant and possibly reversible hemodynamic changes in the cardiovascular system, which provide for the proper growth and development of the foetus and prepare the mother’s body for delivery and the postpartum period
Due to the growing population of pregnant women suffering from cardiovascular disease (CVD), in 2018, the European Society of Cardiology (ESC) published detailed guidelines for treating those patients [4], putting the most significant impact on multidisciplinary cooperation between gynaecologists, cardiologists, and anaesthesiologists
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Summary
Pregnancy is a physiologic dynamic process associated with significant and possibly reversible hemodynamic changes in the cardiovascular system, which provide for the proper growth and development of the foetus and prepare the mother’s body for delivery and the postpartum period. Adaptive changes such as increased cardiac output, arterial compliance and the extracellular fluid volume, and lowered blood pressure and total vascular resistance may exacerbate symptoms of existing CVD and substantially increase the risk of maternal and foetal death [1]. A multidisciplinary approach is recommended to ensure the safety and effectiveness of management in these unique medical conditions
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