Cardio-Obstetrics Fundamentals for Fellows-Introduction, Hemodynamics and Screening

Video Transcription

Video Summary

This educational module on Cardio Obstetrics Fundamentals targets cardiovascular and maternal fetal medicine fellows to improve recognition and management of cardiovascular disease (CVD) in pregnancy, a leading cause of maternal morbidity and mortality. Dr. Allison Bryant highlights that the U.S. has rising maternal mortality rates, disproportionately affecting Black and American Indian/Alaska Native women, with CVD accounting for over a quarter of deaths. Most cardiovascular-related maternal deaths occur postpartum and are preventable. Social determinants and healthcare system factors, including provider knowledge and implicit biases, contribute to disparities. Recommendations emphasize provider education, guideline adherence, and expanded postpartum Medicaid coverage.<br /><br />Dr. DeFaria Yeh reviews normal pregnancy hemodynamics: heart rate rises 15–20%, plasma volume increases nearly 50%, systemic and pulmonary vascular resistance drop, and cardiac output increases about 50%. These changes can unmask latent heart disease, especially during late pregnancy and early postpartum when systemic vascular resistance surges. Normal exam findings include systolic murmurs and ECG changes; abnormal signs like tachycardia above 110, hypoxia, and diastolic murmurs warrant prompt evaluation.<br /><br />Dr. Afshan Hameed discusses preconception counseling and cardiovascular risk stratification using models like CARPREG II and WHO classification, underscoring that women with persistent left ventricular dysfunction (WHO class IV) should be advised against pregnancy. Cardiometabolic risk factors—hypertension, obesity, diabetes—must be optimized before conception. Universal cardiovascular risk screening during pregnancy/postpartum with labs, echocardiogram, and ECG improves early detection. Safe medication management and early prenatal care are essential to reduce maternal and fetal risks related to CVD.

Keywords

Cardio Obstetrics

Cardiovascular Disease in Pregnancy

Maternal Mortality

Pregnancy Hemodynamics

Preconception Counseling

Cardiovascular Risk Stratification

Postpartum Cardiovascular Care

Maternal Health Disparities