Reviewer: Jamie Morgan, MD (University of Texas Southwestern Medical Center)
Description: The maternal mortality epidemic in the U.S. has highlighted gaps in pregnancy-related care, in particular for women with congenital or acquired heart disease. This book addresses many of these pertinent gaps in care, outlining strategies to optimize maternal outcomes for pregnant women with coexistent cardiovascular disease. Each chapter summarizes take-home principles and uses complementary tables, figures, and textboxes that highlight key points and underscore clinical pearls.
Purpose: The purpose is to provide practical guidance for the management of cardio-obstetric patients. This heavily clinical focus augments and supports evidence-based care of pregnant women with cardiovascular disease, directly addressing knowledge deficits and treatment shortfalls that have contributed to rising national maternal morbidity and mortality figures.
Audience: This book is most appropriate for general obstetricians, maternal-fetal medicine physicians, and cardiologists interested in pregnancy care. Medical students and residents in both internal medicine and obstetrics/gynecology may benefit from specific sections, although the book will largely exceed their expected level of knowledge. The 37 well-regarded authors and contributors have the pertinent expertise in cardiology, perinatology, and critical care medicine needed to successfully serve the target audience.
Features: The 21 well-referenced chapters cover the gamut of cardiovascular care during pregnancy. The beginning chapters focus on broader topics such as pregnancy physiology, anesthesia considerations, preconception counseling, and contraceptive options. Later chapters delve into specific cardiac conditions, including optimal antepartum, intrapartum, and postpartum management strategies for each one. Overall, the book is clear, understandable, and accessible. The breadth and depth of the material is appropriate for practicing clinicians. Chapters addressing common and often challenging management issues such as diagnostic imaging, anticoagulation, and medication safety are high-yield and likely to be heavily referenced. The many diagrams, algorithms, tables, and textboxes throughout the book recapitulate salient content, a definite highlight for readers. There is some redundancy between chapters, which may benefit from cross-referencing rather than reiteration. Although the book covers a broad range of clinical topics, a chapter devoted to quality improvement efforts surrounding cardiac care in pregnancy would be a welcome addition to future editions. In this first edition, the quality improvement-related topics (maternal mortality review committees, levels of maternal care, simulation, multidisciplinary case review, etc.) are cursorily mentioned and randomly interspersed. Further exploration and guidance on these QI topics would add to the book's scope and purpose.
Assessment: This comprehensive and clinically focused book is a welcome addition to the obstetrical literature. Although long-standing publications such as Williams Obstetrics, 25th edition, Cunningham et al. (McGraw Hill, 2018), and Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 8th edition, Resnik et al. (Elsevier, 2019), include sections on maternal cardiac disease, this book's dedicated emphasis on the cardio-obstetrical patient as well as the management-focused content set it apart from these renowned books. In comparison to Cardiac Problems in Pregnancy, 4th edition, Elkayam (Wiley-Blackwell, 2020), this book offers approachable, on-the-spot clinical advice in contrast to the more expansive scope of that lengthier book. This is certainly a book that many obstetricians and maternal-fetal medicine providers, including me, will be adding to their collection.
