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The key to successful care for pregnant women in heart failure? Team concern, the study finds



The key to successful care for pregnant women in heart failure? Team concern, the study finds

Every time a pregnant woman has heart failure, there are risks for both mother and baby. What is needed to protect the mother and her baby for the best possible outcome?

According to clinicians at Intermountain Healthcare in Salt Lake Citia, the key to survival is a multidisciplinary team approach that includes cardiac and maternal / fetal / newborn experts – who usually do not work together – to team up to successfully save mum and babi.

In a case study presented at the American College of Cardiology Scientific Sessions at Nev Orlyans on March 16, clinics from the Intermountain Healthcare Heart Institute found that more medical teams in several different disciplines saved lives and mothers and children after being moved from a smaller, local hospital.

"This case represents a huge team effort and shows what it takes to see a critically ill patient through a unique and very challenging disease," says Kismet Rasmusson, DNP, FNP, Intermountain Healthcare Heart Institute.

A 30-year-old patient was in the 22 weeks pregnant when he came to the hospital with insufficient breath, but without a previous history of heart disease.

When doctors realized that her heart was failing – or because of idiopathic cardiomyopathy with an unknown cause or cardiomyopathy associated with pregnancy – she was transferred to the Heart Institute Intermountain Medical Center.

Cardiomyopathy leads to cardiac insufficiency – a heart muscle disease that makes the heart difficult to pump into the rest of the body. About 6.2 million Americans have some kind of heart failure, including women and men. According to a recent study in JAMA, maternal mortality in the United States is high, 10% of them related to cardiomyopathy, but 60% can be prevented with optimal treatment and coordination of care. That's exactly what this team had to offer to this patient.

Seven weeks, mother's care was led by several teams, including cardiologists with cardiac insufficiency with the OB team. In order to develop a complete care plan, the rest of the team was composed of critical care clinics, emergency cardiologists, cardiac surgeons, specialized nurses, surgical and surgical laboratories, chest radiographs and newborn infants, pharmacists, advanced clinicians practices, and cardiovascular nurses. Social workers also supported the patient and her husband.

"We had two goals – first of all, the baby was mature enough to have a better outcome, and secondly that mom would be as stable as we could with her terribly weak heart muscles," Rasmusson said.

The baby was born for 29 weeks – about 11 weeks earlier. The team knew that delivery was risky and should have been planned in advance. They held two meetings before the delivery date to discuss the sequence of events and roles of all members of the team, which involved the mechanical support of the mother's heart during the Cesarean surgery at the laboratory for cardiac catheterization.

The order of complicated delivery included intubation, insertion of the catheter into the pulmonary artery, temporary insertion of mechanical support, cesarean delivery, the sending of the baby to the intensive care unit of the newborn with the father, and postpartum monitoring.

After delivery, the heart of the mother remained very weak, so that an LVAD auxiliary device was implanted, which provided sustained mechanical support for her heart and served as a heart transplant, which she received eight months after delivery.

The baby is now almost five years old, and the baby and mother are good, says Rasmusson.

"The patient in this unique case had the best possible outcome we all hoped for," she added. "Only through experts within our various teams, who have the depth of their skills and experience, and our commitment to providing the best care, it could be possible for women as in this case and for others like her."

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This story is published on: 2019-03-17. To contact the author, use the details of the contact in the article.

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