The most recent UK maternal mortality review for which details of cardiac deaths are available is for
. The majority of deaths occurred in women with structurally normal hearts, many of
whom were not known to have heart disease prior to pregnancy: their disease was revealed or
precipitated by the hormonal and haemodynamic changes associated with pregnancy. Importantly,
care was deemed to be substandard in >50% of the cardiac deaths, and in half of these cases better care
may have resulted in a different outcome. The increase in cardiac mortality found between 2006 and
2008 is likely to be a reflection of the changing demographics of the overall obstetric population with
increasing maternal age, obesity and smoking. All the women who died from ischaemic heart disease
had at least one identifiable risk factor. The detailed review of the cases in the report identified the
importance of having a low threshold for investigation and cardiological review of women who present
with possible cardiac symptoms during pregnancy or the post-partum period; therefore, investigations
should not be withheld because of pregnancy.