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PHYSIOLOGICAL CONSIDERATIONS IN PREGNANCY.. . 948
DISEASE ................... 949
PERIPARTUM MANAGEMENT CONSIDERATIONS ..... 951 SURGICALLY DISEASE.. . . . . . . . . . 954 VALVULAR HEART DISEASE ...................... 955
CONGENITAL HEART DISEASE . . . . . . . . . . . . . . . . . . . . 958 PULMONARY HYPERTENSION . . . . . . . . . . . . . . . . . . . . 960
CARDIOMYOPATHIES ........................... 962
HEART FAILURE ................................ 964
INFECTIVE ENDOCARDITIS ....................... 965
ARRHYTHMIAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 965
DISEASES OF THE AORTA ........................ 967
ISCHEMIC HEART DISEASE . . . . . . . . . . . . . . . . . . . . . . . 968
Some authorities recommend that women suering rom heart lesions be dissuaded rom marriage. This, however, appears to be an extreme view, though, of course, when the lesion is serious and the compensation auly, the dangers of childbearing should be caruly explaine.
-J. Whitridge Williams (1903)
As Williams recognized more than a century ago, pregnancy in those with signiicant heart disease can be extremely hazardous and may lead to decompensation and death. In an analysis of maternal mortality in the United States between 2011 and 2013, the causes previously responsible for most maternal deaths-hemorrhage, hypertensive disorders, and embolism-continued to show declining rates. In contrast, deaths attributable to cardiovascular diseases were responsible for approximately 26 percent of all pregnancy-related deaths (Creanga, 2017). Cardiovascular diseases also account for significant maternal morbidity and are a prominent reason for obstetrical intensive care unit admissions (Small, 2012).