Pregnancy and heart conditions

nThe Leeds

Teaching HospitalsNHS Trust

Cardio-RespiratoryCSU

Pregnancy and heart conditions

Information for patients

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What should I know?Having a heart condition can affect the way your body copes with pregnancy. Many women with a heart condition will tolerate pregnancy well. However, depending on the nature of your heart condition, there may be some risks to you and your baby.

There are a small number of cases where pregnancy would be considered high risk and in some very high risk cases we might advise a woman to avoid becoming pregnant.

For most people this risk is low but we would always advise speaking to your healthcare professional before thinking about getting pregnant so that you can get advice which is individual to you. This is called “preconception counseling”.

We would usually advise that women with a heart condition avoid an unplanned pregnancy where possible, you should ensure that you have an appropriate plan in place in relation to contraception.

Complications in pregnancy can be reduced and prevented by preconception assessment and planning. This may not always be possible therefore this leaflet will also provide guidance on what to do if you become pregnant without prior planning.

What are the risks during pregnancy?Any pregnancy carries a small risk of problems or complications for the mother or baby. In most cases this risk is very low, but the presence of any heart condition can increase the chance of problems during pregnancy, delivery or after the pregnancy. The risks will vary depending on the nature and severity of your heart condition.

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What factors can increase risk?

Your potential risk in pregnancy is dependent on a few factors:

• Your ventricular function (the strength of the pumping chambers of your heart)

• Any leaky or narrowed heart valves or a mechanical heart valve replacement

• Your oxygen levels

• Any heart rhythm problems you have had or continue to have

• Any heart problems in previous pregnancies

• Previous problems with the blood vessels that supply your heart with blood

• Your symptoms before pregnancy

• The medications you are prescribed

How is risk in pregnancy assessed?

• Healthcare professionals have experience managing women throughout pregnancy with a variety of heart conditions. They have access to international consensus expert guidance

• Pregnancy related risk is also often assessed using the modified World Health Organisation (mWHO) classification

• Women who have a heart condition and wish to become pregnant should speak to their cardiologist and/or be referred to a specialist Cardio-Obstetrics clinic for pre- conception counselling. This will allow for a formal assessment of pregnancy risk by a multidisciplinary specialist team.

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What does pre-conception counselling involve? • The goal of pre-conception care is to improve the long and

short-term health outcomes of women and their children. If a woman has a chronic medical condition, specific pre-conception management advice including specialist referral may be offered.

• In many cases the discussion at this appointment will be straightforward, particularly if you have a mild or minor heart condition. It will involve talking to a cardiologist experienced in caring for women during pregnancy, you may also meet an obstetrician and a clinical nurse specialist to support you during this time.

• Your doctor or other health professional should take account of your background and other health conditions, they are likely to discuss any current symptoms you experience which are related to your heart condition.

• In some cases, you may require further tests such as an ECG (heart tracing), echocardiogram (heart scan), ambulatory ECG (a more prolonged recording of your heart) or exercise test to assess the risk of complications.

• You may be advised to address other factors such as smoking or weight loss which can help reduce the risks to you and the baby. You may also be asked to consider treatments to improve the symptoms of your heart condition prior to getting pregnant.

• You should have been advised if your heart condition is considered to be inherited. In such cases, and where there is an identified disease causing genetic mutation, you may want to discuss pre-implantation genetic diagnosis (PGD) and testing.

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• Mental health and well-being support is also available through these specialist clinics.

• During pregnancy, follow up for woman with heart conditions is recommended and is often organised through the Cardio-Obstetrics clinic. The same team can monitor your heart condition throughout pregnancy, make a plan for the later stages of pregnancy and advise on the safest approach to delivery.

It is advised that women with a heart condition avoid an unplanned pregnancy. This gives you time to have a discussion with your healthcare professional about pregnancy and any risk there may be.

Contraception • Some forms of contraception may be unsuitable for use in

certain heart conditions. For example, oral contraceptives such as the combined pill contain oestrogen, this may increase blood pressure and can increase the risk of developing deep vein thrombosis (DVT’s). In some heart conditions this would need to be avoided.

• In general, long-acting reversible contraceptives such as the progesterone injection or implant are safe, reliable and are well tolerated.

• More information about using contraceptives safely when you have a heart condition can be found at: www.bhf.org.uk

You can discuss your options for contraception with your GP and practice nurse but you may find that they wish to seek advice from your cardiology team before making a decision. Your cardiology consultant or cardiac nurse specialist may be happy to offer advice based on your heart condition.

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What about my cardiac medications during pregnancy? • It is important that you do not to stop any of your cardiac

medications without first consulting your cardiology team.

• Some medications are safe to use in pregnancy and while breast feeding.

• Other medications may need to be stopped for safety, in this case and depending on your heart condition, it may be important to take an alternative medication.

• A medication review will take place at pre-conception counselling and you will have the opportunity to discuss the implications of continuing cardiac medications throughout pregnancy with your cardiology team.

• If you become pregnant without the opportunity to have this discussion it is important that you contact your cardiology team as soon as possible for advice but do not stop any medications in the meantime.

I might be pregnant – what should I do? • If you become pregnant and you have a heart condition,

it is important to be in touch with your cardiology team as soon as possible.

• You could contact your cardiology consultant or your cardiac nurse specialist if you have one.

• Your cardiology team will offer you some initial advice, this may be the time to ask about your medications. They may then arrange for you to attend a specialist clinic which combines both cardiology and obstetric support.

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• You will be monitored in this clinic at regular intervals throughout your pregnancy. You will be monitored as much or as little as is required depending on your heart condition.

• You should also notify your GP of your pregnancy and contact your midwife to arrange a booking in appointment as you usually would.

Where can I find more information?

British Heart Foundation

Telephone: 0300 330 3311 Website: www.bhf.org.uk

Cardiomyopathy UK

Telephone: 0800 018 1024 Website: www.cardiomyopathy.org

Marfan Association

Telephone: 0125 281 0472 Website: www.marfan-association.org.uk

Pumping Marvellous

Telephone: 0800 978 8133 Website: www.pumpingmarvellous.org

Scottish Obstetric Cardiology Network

Website: www.socn.scot.nhs.uk

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ReferencesThe following resources contributed to the production of this leaflet.

Scottish Obstetric Cardiology Network

Website: www.socn.scot.nhs.uk

2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiovascular-Diseases-during-Pregnancy-Management-of

Intrapartum care: existing medical conditions and obstetric complications Quality Standard [QS192] 2020 https://www.nice.org.uk/guidance/qs192

Pregnancy with a heart condition, BHF guidance https://www.bhf.org.uk/informationsupport/support/practical-support/pregnancy-with-a-heart-condition

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THE PUBLICATION OF THIS BOOKLET HAS BEEN FINANCED BY TAKE HEART

Registered Charity No. 1002063

Raising funds exclusively for the

Yorkshire Heart Centre

at Leeds General Infirmary,

St James’s Hospital

and its units within the

Leeds Teaching Hospitals NHS Trust

TAKE HEARTF Floor, Jubilee Building,

The General Infirmary at Leeds, LEEDS, LS1 3EXTelephone: 0113 392 2888

Email: [email protected] Web: www.takeheart.net

PLEASE READ ABOUT TAKE HEART AT REAR OF THIS BOOKLET

MEMBERSHIP APPLICATIONMembership of TAKE HEART is open to anyone for a once only fee of £1.50. In return you will receive a regular newsletter keeping you informed of the charity’s activities. YOU CAN ALSO JOIN ONLINE AT: www.takeheart.net

Title: ........................ Surname(s): .........................................................................................................

First Names: Member 1: .........................................................................................................

Member 2: .........................................................................................................

Address: ..............................................................................................................................................

............................................................................................................................................................

...................................................................................... Postcode: ......................................................

Telephone: ............................................................................Date: ......................................................

An attractive Take Heart badge is available at £1.00. Please indicate the quantity required and add the cost to the Membership fee.

No of Badges required: .................................................................

I enclose a cheque/postal order for £ ............................................................payable to TAKE HEART.

DONATION FORMDonations should be sent to: THE TREASURER, TAKE HEART, ‘F’ FLOOR, JUBILEE WING, LEEDS GENERAL INFIRMARY, LEEDS LS1 3EX.

I would like to make a donation of £ ............................................................................ to TAKE HEART.

Name: ..................................................................................................................................................

Address: ..............................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

Postcode: ..............................................................................Date: ......................................................

If you are a UK taxpayer, the Charity can benefit further from your donation.

If you would like further details, please tick this box: nPLEASE MAKE ALL CHEQUES PAYABLE TO TAKE HEART.

DONATIONS ARE ALWAYS WELCOME AND WILL BE ACKNOWLEDGED, AND PUBLISHED IN OUR NEWSLETTER

Please send completed Membership/Donation forms to:THE TREASURER, TAKE HEART, ‘F’ FLOOR, JUBILEE WING,

LEEDS GENERAL INFIRMARY, LEEDS LS1 3EX. TEL: 0113 392 288.

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THE PUBLICATION OF THIS BOOKLET HAS BEEN FINANCED BY TAKE HEART


Raising funds exclusively for the

Yorkshire Heart Centre

at Leeds General Infirmary,

St James’s Hospital

and its units within the

Leeds Teaching Hospitals NHS Trust

TAKE HEARTF Floor, Jubilee Building,

The General Infirmary at Leeds, LEEDS, LS1 3EXTelephone: 0113 392 2888

Email: [email protected] Web: www.takeheart.net

PLEASE READ ABOUT TAKE HEART AT REAR OF THIS BOOKLET

MEMBERSHIP APPLICATIONMembership of TAKE HEART is open to anyone for a once only fee of £1.50. In return you will receive a regular newsletter keeping you informed of the charity’s activities. YOU CAN ALSO JOIN ONLINE AT: www.takeheart.net

Title: ........................ Surname(s): .........................................................................................................

First Names: Member 1: .........................................................................................................

Member 2: .........................................................................................................

Address: ..............................................................................................................................................

............................................................................................................................................................

...................................................................................... Postcode: ......................................................

Telephone: ............................................................................Date: ......................................................

An attractive Take Heart badge is available at £1.00. Please indicate the quantity required and add the cost to the Membership fee.

No of Badges required: .................................................................

I enclose a cheque/postal order for £ ............................................................payable to TAKE HEART.

DONATION FORMDonations should be sent to: THE TREASURER, TAKE HEART, ‘F’ FLOOR, JUBILEE WING, LEEDS GENERAL INFIRMARY, LEEDS LS1 3EX.

I would like to make a donation of £ ............................................................................ to TAKE HEART.

Name: ..................................................................................................................................................

Address: ..............................................................................................................................................

............................................................................................................................................................

............................................................................................................................................................

Postcode: ..............................................................................Date: ......................................................

If you are a UK taxpayer, the Charity can benefit further from your donation.

If you would like further details, please tick this box: nPLEASE MAKE ALL CHEQUES PAYABLE TO TAKE HEART.

DONATIONS ARE ALWAYS WELCOME AND WILL BE ACKNOWLEDGED, AND PUBLISHED IN OUR NEWSLETTER

Please send completed Membership/Donation forms to:THE TREASURER, TAKE HEART, ‘F’ FLOOR, JUBILEE WING,

LEEDS GENERAL INFIRMARY, LEEDS LS1 3EX. TEL: 0113 392 288.

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We are Take HeartTake Heart is a small, but professional charity, run on a completely voluntary basis, raising funds exclusively for the Yorkshire Heart Centre at Leeds General Infirmary, St James’s hospital and its units within The Leeds Teaching Hospitals NHS Trust. We were founded in 1989 by a small number of heart patients wishing to return something for the excellent care received.

From a small beginning, we have raised over five million pounds and this has been used to provide comfort and enhance the surroundings for the many thousands who visit the centre every year. We have also made significant progress in supporting staff in their work and improving their working environment.

Some of the major achievements of the charity are the provision of a suite of relatives rooms available free of charge when required, a roof garden providing a peaceful area for patients and relatives, and an internal garden. We provide free bedside television, free telephone calls and free internet for all patients on the heart wards and we have recently provided changing rooms for an additional MRI scanner. Take Heart have refurbished most waiting areas and made sure that patients enjoy comfort of the highest standard. We also fund information booklets (such as the one you are now reading) which are available in all the Heart Centre wards.

Look around and you will see many items provided by Take Heart. One of the schemes we are most proud of is the Take Heart Suite, costing nearly £500,000. This suite has been created to provide a unit for patients to be admitted to instead of a ward for planned procedures such as pacemakers.


WE ARE TAKE HEART

Take Heart is a small, but professional charity, run on a completely voluntary basis, raising funds exclusively for the Yorkshire Heart Centre at Leeds General Infirmary, St James’s hospital and its units within The Leeds Teaching Hospitals NHS Trust. We were founded in 1989 by a small number of heart patients wishing to return something for the excellent care received.

From a small beginning, we have raised nearly four million pounds and this has been used to provide comfort and enhance the surroundings for the many thousands who visit the centre every year. We have also made significant progress in supporting staff in their work and improving their working environment.


Look around and you will see that all the bedside furniture in the heart wards was provided by Take Heart. We also provide equipment to help bring the latest technology into the centre which, in some cases, helps to reduce waiting times. Our latest major projects include two new portable echo machines and an Intracoronary Optical Coherence Tomography Scanner, (catheter-based invasive imaging systems using light rather than ultrasound for detailed examination of stents), costing in excess of £165,000 and complete refurbishment of the Roof Garden and spent some £60,000 on a major refurbishment of Ward L16.

Take Heart funds are raised in many ways - through donations - events - sponsorship, and bequests, mainly through its thousands of members and supporters.

We would love you to become a member of Take Heart. As a member, you will receive our newsletter about five times a year and if you wish to take part in anything, this is absolutely at your choice. Please note that you will never be bombarded with follow-up mail. You can join by going to our web site www.takeheart.net or picking up a form from any ward reception area.

Gina McGawley Use your SmartPhoneChairman, Take Heart. to visit our website

FOR MORE INFORMATION CONTACT: Take Heart, ‘F’ Floor, Jubilee Building, Leeds General Infirmary, Leeds LS1 3EX. Tel: 0113 392 2888. Email: [email protected] Web: www.takeheart.net

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WE ARE TAKE HEART









This increases the number of patients who can be treated in a day and reduces waiting times, In the first year alone over 1,000 patients went through the suite. Patients can relax there in comfort after their procedure before they go home. The staff who work there get so much positive feedback from patients and they love working in the new environment.



Gina McGawley, Chairman, Take Heart.

For more information contact:

Take Heart, ‘F’ Floor, Jubilee Building, Leeds General Infirmary, Leeds LS1 3EX.

Tel: 0113 392 2888 Email: [email protected] Website: www.takeheart.net


WE ARE TAKE HEART









Use your SmartPhone to visit our website:

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LN005074Publication date

07/2021Review date

07/2023

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Raising funds exclusively for the Yorkshire Heart Centre at Leeds General Infirmary, St James’s Hospital and its units within the Leeds Teaching Hospitals NHS Trust.


Pregnancy and heart conditions

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Transcript of Pregnancy and heart conditions