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Over the past 30 years, the number of pregnancy-related deaths in the U.S. has more than doubled, from 7.2 women dying per 100,000 live births in 1987 to 16.9 women in 2016. By comparison, on average in high-income countries, 11 women die for every 100,000 live births.

CVD a leading cause of maternal mortality.

There are many reasons why more women die from pregnancy-related causes in the U.S. than in other developed countries; our dysfunctional health care system is, of course, a central problem. But is there more that nurses can do to ensure safe and healthy pregnancies?

“Cardiovascular diseases constitute a leading cause of maternal and fetal mortality in pregnant women… [In recent studies], inadequate peripartum follow-up—such as failure to evaluate new symptoms, reevaluate existing symptoms, or respond to changes without delay—was responsible for between one-quarter and two-thirds of deaths associated with pregnancy-specific cardiovascular diseases.”

That’s from “Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy:  A Clinical Review,” in the November issue of AJN. In this CE feature article, Maheu-Cadotte and colleagues at the Université de Montréal provide an update on the current management of gestational hypertension, preeclampsia, and peripartum cardiomyopathy.

Risks before, during, and after pregnancy.

The authors make clear that these conditions not only present a danger to women during the peripartum period, but also present potential risks well after the end of the pregnancy.

  • “Gestational hypertension…has been associated with higher risk of developing diabetes and kidney disease in later life.”
  • “…preeclampsia significantly increases the risk of cardiopulmonary failure and cerebrovascular accident later in life.”
  • “…about one-third of women who have had peripartum cardiomyopathy experience relapse in subsequent pregnancies.”

Be alert for new symptoms or symptom progression.

The authors therefore stress that it’s vital for nurses to be alert for new symptoms during a woman’s pregnancy, as well as for the progression of existing ones. Of particular concern is the presentation of peripartum cardiomyopathy, where dyspnea, edema, and excessive fatigue may appear to be normal changes of pregnancy:

“Peripartum cardiomyopathy often manifests not only with physical symptoms…but also with emotional symptoms such as anxiety, panic, and helplessness. Delays in diagnosis can exacerbate such feelings.”

Good monitoring and early recognition, then, are essential not only in order to address these feelings of foreboding, but ultimately to prevent the progression of cardiomyopathy.

Read this succinct and informative article.