1. Scottish Obstetric Cardiology Network
Maggie Simpson - SOCN Lead Clinician
Mhairi Gallacher - Programme Manager
Kirsty Young - Programme Support Officer
Improving
care for women of child
bearing age with a cardiac diagnosis

2. Cardiac disease in pregnancy
1-4% of pregnancies are complicated by cardiovascular disease
Cardiac disease the leading cause of indirect maternal death
49 maternal deaths 2011 – 13 (2.06/100,000 maternities)
12 sudden adult death syndrome
10 acute coronary syndrome
6 cardiomyopathy
11 other cardiac conditions (aortic dissection, PAH, machinal heart valve thrombosis, endocarditis)
77% of women were not known to have a cardiac diagnosis prior to pregnancy

3. Key messages – MBRRACE 2016
Communication
Recognition

4. Maternal morbidity Maternal mortality is the tip of the iceberg
For every woman who dies, 100 women survive the pregnancy but with severe morbidity
Maternal morbidity
Headline grabber and rightly receives focus, however
105 (74%) infants survived, 36 died (24 stillborn and 12 neonatal deaths).
The women who died left behind a further 253 children, thus together a total of 358 motherless children remain.
Mother living with health problems, psych burden
Babies born may be premature or SGA which may lead to ongoing developmental issues for the baby
Poor fetal outcomes to an enormous emotional and psychological cost to the parents
there is also a cost implications for the NHS.

5. What does this mean in Scotland?

6. Scottish Obstetric Cardiology Network -Aims
To improve equity of care for women with pre-existing cardiac conditions before pregnancy or who go on to develop cardiac conditions during pregnancy
Highlight the potential points in the clinical pathway of care to improve outcomes from pre-pregnancy counselling right through to post-partum care and contraception, including when assisted conception is being planned
Facilitate collaboration within and across the multi-disciplinary teams involved in a woman’s care at local, regional and national levels.
Scottish Obstetric Cardiology Network -Aims

7. Stakeholders Midwives Primary care Assisted conception services
Cardiology
Anaesthetics
Assisted conception services
Haematology
Nurses
Obstetrics
Midwives
Patients
Pharmacy
Sexual health services
Stakeholders
Genetics

8. I know nothing about risk in pregnancy
I don’t care for women in pregnancy….
Who can I refer this woman to for further advice?
I don’t know what contraceptive advice to provide
Who can I contact for advice

9. Pre-pregnancy counselling Data collection / audit
Care Pathways
Pre-pregnancy counselling
Data collection / audit
MDT / Education
Communication

10. Pre-pregnancy counselling
Care Pathways
Pre-pregnancy counselling
Data collection / audit
MDT / Education
Communication

11. IT’S NOT A CONTRACEPTIVE
You can’t get
pregnant on
Ramipril
IT’S NOT A CONTRACEPTIVE

12. ESC 2018

13. ESC 2018
ESC CVD in pregnancy, 2018 pg 11

14. MDT / Education Care Pathways Communication Data collection / audit
Pre-pregnancy counselling

15. Target educational and training opportunities for healthcare providers :
Emergency care
Physicians
Cardiology
Obstetrics
Anaesthesia
Midwifery
Primary care physicians
Sexual health clinics
Education
This will increase the likelihood of a cardiac condition being recognised and managed promptly and consistently
It will also ensure consideration of how, where and who should be involved in counselling and antenatal care of the woman
Steering group
Education/MDT

16. Communication Care Pathways Pre-pregnancy counselling
Data collection / audit
MDT / Education
Communication

17. I didn’t know who to call
Ensure that appropriate clinicians at local, regional and national level are identified
Where local expertise is not available the network will enable access to an alternative source of advice
Facilitate connection with local units and collaboration with regional and national teams
Effective communication and engagement with patients will ensure the network will meet their needs and they feel empowered to play a role in their care
Communication
I didn’t know who to call
local teams can have confidence in decision making and management of cases at a local level and avoid unnecessary patient transfer
Steering group
Communication

18. The network will:
Develop pathways of care to ensure standardised care for women across Scotland with a cardiac condition pre-pregnancy, antenatally and in the post-partum period
Provide a structure for multidisciplinary team working including emergency situations
Advance education and training opportunities in the care of women of child bearing with a cardiac diagnosis
Establish a mechanism for data collection and audit
Ensure ongoing involvement of patients and the public in the network ensuring their views are represented and acknowledged
SOCN
We will provide a foundation that will reduce morbidity in women with pregnancy complicated by cardiovascular disease

19. Thank you