Heart and Lung Disorders Complicating Pregnancy and the Puerperium: Pitfalls in Practice & Lessons Learned

Objective: To review a case series of 12 women with unexpected heart and lung disorders that occurred during pregnancy and the puerperium, describing for teaching purposes the pitfalls in practice and the lessons learned from this experience. Materials & Methods: We reviewed case files of women with medical and/or hypertensive complications of pregnancy that were evaluated for medicolegal defense purposes by the first author between 1986-2015. Twelve women in these case files experienced unexpected cardiovascular and/or cardiopulmonary complications late in pregnancy or early in the puerperium. For each case, the pertinent medical record information was extracted. Important concepts as lessons learned are summarized and referenced for teaching purposes. Results: Five women had undetected preexisting heart disease which acutely deteriorated during the third trimester, four women developed postpartum heart failure related to pregnancy and delivery, and three women suffered an intrapartum cardiac arrest; none survived. Their case presentations illustrate the importance of obstetric health care professionals being alert to the signs/symptoms of developing cardiopulmonary disease late in pregnancy and following delivery so that timely evaluation and intervention can be accomplished to potentially avoid morbidity and mortality. Diagnostic categories include peripartum heart failure, high-risk chronic hypertension, superimposed preeclampsia, amniotic fluid embolism, pulmonary embolism and Raynaud’s with occult pulmonary hypertension. Conclusion: These cases illustrate the diversity of ways that cardiovascular disease can suddenly complicate pregnancy and the early postpartum period. A major part of any effort to enhance safer motherhood is a heightened awareness by obstetric specialists to consider the possibility of heart disease in all maternity patients so that appropriate consultation and collaboration with other specialists might help avoid major maternal morbidity or mortality.