Getting to the Heart of It

From the beginning to the end of pregnancy (and beyond), Temple Health’s Cardio-Obstetrics Program manages both pre-existing heart conditions and those that develop during pregnancy to ensure the best outcomes for mother and baby. Here, the co-directors of the program, Drs. Laura Hart and Deborah Crabbe, explain how the program achieves better outcomes for at-risk parents and their children.

›› What makes the Cardio-Obstetrics Program at Temple unique in terms of patient care?  Dr. Deborah Crabbe: You’re looking at a program that has a very close collaboration between two sub-specialties: high-risk MFM (Maternal-Fetal Medicine), and people that are in cardiology, for which we have a beautiful array of specialists in the areas of electrophysiology, pulmonary hypertension, CT surgery and general cardiology. All of these are partners that are very advanced in their field, so you’ll have those tools at your disposal.
Dr. Laura Hart: It’s also the communication between the various disciplines that we work with. We are in constant communication between our specialists and emergency room physicians. And we educate emergency room providers on the signs and symptoms of cardiovascular disease, especially during the postpartum period.

›› Which groups of patients are most at risk, and how do they benefit from early intervention? DC: Patients with pre-existing cardiovascular conditions like heart failure, hypertension or congenital heart disease are at higher risk during pregnancy. If they’re referred earlier, we can manage their condition right from the start, and that makes a huge difference. For example, early involvement of specialists in managing cardiovascular conditions can improve outcomes for these patients.

›› How does your program manage long-term health outcomes for both mother and child? DC: There are conditions that you develop during pregnancy, like preeclampsia, that have long-term impacts. If you have uncontrolled hypertension during pregnancy, you could develop heart failure 10 to 15 years later. The goal is to identify those patients who are at higher risk and work on risk management, such as controlling obesity, diet and lipids for the long-term, to prevent the progression of cardiovascular diseases later on. LH: And our care doesn’t end at delivery. During the “fourth trimester,” we continue to monitor patients, especially for complications like preeclampsia and other cardiovascular disorders. We do blood pressure monitoring, office visits, home visits and follow-up studies like echocardiograms. We also educate patients on signs and symptoms to watch for during the postpartum period.

›› What are some ways your program is making progress in how care is provided? LH: There’s a lot of education needed, both for OB providers and cardiologists, in terms of recognizing cardiovascular risk factors and symptoms. We provide that education so patients get referred to us earlier. We also do community education, reaching out to patients and those who work closely with them, like doulas and health workers, to make sure they know the signs and symptoms to look out for. They can then refer patients into our program before complications arise. DC: We are implementing systems to catch high-risk patients early. We’re a member of the Peripartum Cardiomyopathy Network, a national group dedicated to care for patients with peripartum cardiomyopathy (PPCM), a major cause of maternal morbidity. And we are participating in a clinical trial for PPCM, called REBIRTH, to advance knowledge about the condition.