Cardio-Obstetrics Fundamentals for Fellows-Metabolic Disease, Anticoagulation, Hypertension and Impacts of Childhood Cancer in Pregnancy

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Video Summary

This comprehensive module addresses complex cardiovascular issues encountered during pregnancy, including hyperlipidemia, resistant hypertension, cardiotoxic effects of cancer therapies, and anticoagulation management.<br /><br />Dr. Garima Sharma discusses dyslipidemia and obesity in pregnancy, highlighting significant lipid increases during gestation essential for fetal development but potentially harmful if excessive, risking pancreatitis. She emphasizes pre-pregnancy lipid screening and lifestyle interventions. For severe hypertriglyceridemia, omega-3 fatty acids and strict diets are advised. Statins generally are avoided unless benefits outweigh risks, especially in homozygous familial hypercholesterolemia. Obesity increases adverse pregnancy outcomes; controlled weight gain and exercise per guidelines improve maternal-fetal health. GLP-1 receptor agonists, effective for obesity, are contraindicated during pregnancy.<br /><br />Drs. Malavika Prabhu and Malamo Contores focus on difficult-to-control hypertension. Acute management requires careful blood pressure reduction to avoid maternal organ or fetal placental hypoperfusion, with first-line agents including labetalol and nifedipine. In postpartum hypertension, monitoring is crucial due to risk of preeclampsia with heart failure features, managed with antihypertensives and diuretics. Close follow-up and addressing disparities in postpartum management are important.<br /><br />Dr. Anne-Marie Fogarty reviews pregnancy anticoagulation given increased VTE risk, advocating low-molecular-weight heparin use over warfarin or DOACs. Diagnosis of VTE is challenging; pregnancy-adapted algorithms guide imaging. For patients with mechanical heart valves, individualized strategies balance thrombotic and fetal risks using heparins and warfarin based on dosing and trimester.<br /><br />Dr. Dan Zlatov addresses cardiovascular risks in childhood cancer survivors exposed to cardiotoxic treatments like anthracyclines and radiation. These patients have increased cardiac morbidity during pregnancy, especially those with prior therapy-induced dysfunction. Thorough cardiovascular evaluation including ECG and echocardiogram is essential pre-pregnancy, with specialized care for high-risk individuals.<br /><br />Overall, the module stresses individualized, multidisciplinary care incorporating cardiovascular risk assessment, evidence-based management, and patient-centered decision-making to optimize maternal and fetal outcomes in complex cardio-obstetric scenarios.

Keywords

cardiovascular issues in pregnancy

hyperlipidemia management

resistant hypertension in pregnancy

cardiotoxicity of cancer therapies

anticoagulation during pregnancy

dyslipidemia and obesity

pre-pregnancy lipid screening

pregnancy hypertension treatment

venous thromboembolism (VTE) risk

cardiovascular care in childhood cancer survivors