Severe maternal cardiovascular pathology and pregnancy

The aim of this thesis is to evaluate specific causes of maternal mortality in the Netherlands and to evaluate possibilities to prevent maternal mortality due to CVD (cardiovascular disease) in the future. Furthermore, we focused on certain severe CVD with a high risk of maternal mortality. In chapter 2 we evaluated pregnancies in women who died in the Netherlands due to CVD in the past 21 years. We identified important causes of death (aortic dissection, myocardial infarction, cardiomyopathy, or unexplained). In a minority of the cases, mortality could have been prevented, for this we gave recommendations. In chapter 3-6 we have evaluated myocardial infarction during pregnancy. We described how to recognize this, and the main causes. We concluded that the risk of maternal mortality was high, as well as the risk of complications in the unborn child. In chapter 5 and 6 we studied women who had already had a myocardial infarction and subsequently became pregnant, and concluded that these women were very high risk pregnancies. In chapter 7 we studied pregnancies in women with a heart valve prosthesis. We concluded that these women are at high risk for complications and made recommendations. In Chapter 8 we investigated the use and safety of new anticoagulant drugs, the DOACs, during pregnancy, and discouraged the use of these during pregnancy for safety reasons. In chapter 9 we investigated pulmonary hypertension during pregnancy, and advised to continue to encourage these women not to become pregnant