Reports on Confidential Enquiries into Maternal Deaths: management strategies based on trends in maternal cardiac deaths over 30 years.

In the latest Report of the Confidential Enquiries into Maternal and Child Health (CEMACH; formerly Confidential Enquiries into Maternal Deaths (CEMD)), cardiac disease was the second commonest cause of maternal mortality. Currently there is much emphasis on appropriate referral and multidisciplinary planning for women with known cardiac disease. However, examining all maternal cardiac deaths in the CEMACH/CEMD reports over the last 30 years, to see whether the condition was known before pregnancy or developed during pregnancy, suggests that while reported maternal mortality due to cardiac disease overall has approximately doubled, the number due to known disease has changed little. Thus significant and increasing numbers of deaths occur in women without known disease, either in those with risk factors or in those who develop conditions in the absence of risk factors. Therefore, while there is a continuing need to counsel, refer and appropriately manage women with known pre-existing cardiac disease, attention must also be paid to screening women before pregnancy for evidence of cardiac disease or risk factors, and also to cardiac disease that develops de novo during pregnancy, since early screening and referral strategies alone will not prevent units from encountering such cases. All units therefore require processes for monitoring and managing women for the development of cardiac disease throughout their pregnancies.