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Abstract
Introduction A recent maternal death prompted us to review pre-conception counselling practice for patients with established cardiovascular disease. Cardiovascular disease remains the leading cause of maternal death in the UK-14% of maternal deaths were due to heart disease[1] according to the MBRRACE UK 2023 report. Pre-conception counselling is an important factor to try and reduce these deaths. Guidelines produced by both the European Society of Cardiology and The Royal College of Physicians and Surgeons of Glasgow advise that all women of childbearing age with heart disease are offered pre-pregnancy counselling and contraceptive advice[2,3].
Methodology This audit assessed if pre-pregnancy counselling and contraceptive advice was offered to women of childbearing age with cardiovascular disease at South Tees Hospital Trust.
A cohort of 117 patients was identified using existing databases having been seen in general cardiology clinics, cardiac rehabilitation, heart failure clinics or the valve clinic within the last 2 years who were female and of childbearing age (i.e born after 01/01/2023).
A retrospective analysis was performed of the correspondence between the cardiology clinic (either consultant or allied health professional) and the patient and GP. Data collection focused on; diagnosis, whether pre-pregnancy counselling was offered and who this was done by.
Results A variety of conditions were included; table 1 shows the number of patients with each diagnosis.
Of the patients with LV systolic impairment 52 (63.4%) were categorized as severe. Amongst those diagnosed with coronary artery disease, 20 (83.3%) patients presented with an ST-Elevation MI.
Of the 26 patients who received pre-pregnancy counselling, 7 (26.9%) were only informed of the risks after falling pregnant, Graph 1. A total of 90 (76.9%) patients did not receive any pre-pregnancy counselling. 11 (12.2%) of these women were seen whilst pregnant and future pregnancies were not discussed. One patient sadly died during her presenting admission.
Pre-pregnancy counselling was undertaken by a combination of cardiology doctors and heart failure nurse specialists, Graph 2.
Conclusion Local adherence to guidelines regarding pre-pregnancy counselling is poor and requires improvement. It is vital that patients are informed of the risks of pregnancy to allow for safe care during pregnancy or avoidance of pregnancies.
In order to improve the use of pre-pregnancy counselling our findings have been presented at the local cardiology academic meeting. This highlighted the need to have such discussions in clinic with the clinical team. Pre-pregnancy counselling will also be included in the heart failure clinic database to ensure such discussions are taking place. Finally our interventional nurse specialists will include advice regarding the risks of potentially harmful medications in discharge letters as well as arranging counselling from the pharmacy team.
Summary of cardiovascular diagnoses of the selected patient cohort. LV = left ventricle
Record of pre-pregnancy counselling
Healthcare professionals undertaking pre-pregnancy counselling. HF = heart failure
Conflict of Interest None