ABSTRACT
Cardiac disease is one of the leading causes of maternal mortality in the UK. In the most recent Confidential Enquiries into Maternal Deaths report (2000–2002) it accounted for 44 deaths, the second commonest cause overall. The increase in cardiac deaths is predominantly due to an increase in deaths from acquired heart disease, as those from congenital heart disease have remained fairly constant. Physiological changes within the cardiovascular system during pregnancy are significant, and may lead to functional deterioration in certain conditions. Cardiac output increases by 40% by the end of the second trimester, through increases in both stroke volume and heart rate. Diagnosis of cardiac disease in pregnancy may be difficult, as a number of the symptoms and signs may be present in normal pregnancy. Fatigue, breathlessness, tachycardia and oedema need not necessarily signify cardiac failure. For labour and vaginal delivery, provided that the mother is not fully anticoagulated, low-dose epidural analgesia is recommended.
