Managing cardiovascular disease during pregnancy: best practice to optimize outcomes.

Cardiac disease is the most common cause of death in pregnancy in the U.K. Optimal management requires an understanding of the physiological changes of the cardiovascular system during pregnancy, and their impact on existing or developing heart disease. Pregnancy itself is associated with the onset of cardiomyopathy, and a potential risk factor for ischemic heart disease and aortic dissection. Women with valvular disease and aortopathy require regular follow-up in specialized centers, and those requiring long-term anticoagulation face difficult challenges to balance maternal and fetal risks. In the UK, the Confidential Enquiries into maternal deaths and the UK Obstetric Surveillance system are examples of existing systems for identifying clinical risks and provide examples of potential improvements in care.