Divergent Paths: A Survey of Cardiologist and Obstetrician Decision-Making in High-Risk Pregnancies with Cardiovascular Disease

Emre Uysal,1,2 Nur Gozde Kulhan,2 Oguzhan Gunenc,2 Mehmet Kulhan,3 Ummugulsum Esenkaya2 1Department of Gynecology and Obstetrics, Eregli State Hospital, Konya, 42310, Turkey; 2Department of Gynecology and Obstetrics, Konya City Hospital, Konya, 42000, Turkey; 3Department of Gynecology and Obstetrics, Selcuk University Faculty of Medicine, Konya, 42000, TurkeyCorrespondence: Emre Uysal, Email [email protected]: During pregnancy, there is a physiologic increase in heart rate and blood flow rate along with an increase in plasma volume. Although these changes are physiological, pregnant women with congenital cyanotic heart disease are known to have an increased risk of maternal heart failure, premature birth, intrauterine growth retardation, increased number of cesarean sections, and even maternal death. According to the World Health Organization, cardiovascular diseases (CVD) are the most common cause of indirect maternal deaths. The aim of this study was to assess how well obstetricians and cardiologists manage the care of a pregnant woman with cardiovascular disease.Methods: This survey-based study included 45 obstetricians and 30 cardiologists. There is no ready-made scale or survey on the relevant subject. Therefore, the survey questions were created by us as a result of the literature review. In the survey, questions were asked to examine clinical decision-making tendencies and attitudes of obstetrics and cardiology doctors about recommending induced abortion in the first trimester in pregnant women with various heart diseases and about vaginal labor or cesarean section and infective endocarditis prophylaxis in term pregnancy.Results: Survey responses from obstetricians and cardiologists revealed significant differences in management approaches. Regarding first-trimester elective termination, cardiologists overwhelmingly recommended it for most conditions (eg, 100% for pulmonary arterial hypertension, 96.7% for EF < 30%/Class III–IV heart failure), whereas obstetricians showed greater hesitation or preference for cardiology consultation (eg, 48.9% had “no opinion” for Marfan syndrome with aortic dilatation). For mode of delivery at term, cardiologists predominantly recommended cesarean section, often with infective endocarditis prophylaxis, for specific high-risk conditions (eg, 100% for prosthetic valve, 96.7% for severe PAH). In stark contrast, the majority of obstetricians (ranging from 53.3% to 80.0% across various CVDs) opted to defer the decision by seeking a cardiology consultation. Statistical analysis confirmed significant differences (p< 0.05) between the two specialist groups in most management decisions.Discussion: CVDs are the most common cause of non-direct maternal deaths. Patients should be closely monitored during pregnancy, labor and puerperium. Pregnant women with CVD should be evaluated by a multidisciplinary committee of competent physicians.Keywords: cardiovascular disease, clinical decision-making, physician attitude, infective endocarditis prophylaxis, induced abortion, non-direct maternal mortality