If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If delivered, do not allow breastfeeding. - Nineteenth-century obstetric aphorism on cardiac disease in pregnancy; attributed to Peter1-3
While knowledge about cardiac disease in pregnancy and its management continues to expand, areas of controversy and indecision remain. At what gestation should birth occur? Where in the hospital should the birth occur? What new therapies and treatments can be used in pregnancy? Do new therapies alter the risk of pregnancy? Will this change management? Does this woman need subacute bacterial endocarditis prophylaxis? If anticoagulation is needed, what is the best regimen? The {healthcare} team can often be caught trying to research answers to these questions {while} devising a plan of care that addresses all of the complex needs a woman with cardiac disease during pregnancy can have.
In the perinatal section of this issue, we have tried to address several aspects of cardiac disease in pregnancy. Dobbenga-Rhodes and Prive review assessment and evaluation of the woman with cardiac disease. Witcher and Harvey discuss management of the intrapartum period. More complex cardiac diseases are covered in greater detail in the last {2} articles. McMurtry Baird and Kennedy describe myocardial infarction in pregnancy {while} Palmer reviews peripartum\break cardiomyopathy.
Women with cardiac disease can {present} a challenge to the {healthcare} team. The plan of care and the tasks involved in that plan may concentrate heavily on technical skills and assessment of hemodynamic status. In addition, care will most likely be shared between obstetrical staff and intensive care unit staff. In the effort to provide for the safest birth possible, it is crucial to remember that for this woman and her family this is the birth of their child. Perinatal staff optimize care of these women and their families when they use their combined knowledge of the physiologic principles of cardiac care and family supportive care skills to integrate the psychological and emotional needs of these families with safe physiologic and technical care of the mother. We hope the articles in this section will assist in providing care to this complex population of women.
The neonatal topics for this cardiac issue include a review and continuing education article on patent ductus arteriosus and a study on the emerging area of fetal magnetocardiography. Dr Jacqueline \hbox{McGrath} offers an overview of screening and diagnosis of {congenital heart} disease in her column and Dr Susan Blackburn offers a review of fetal cardiopulmonary physiology and transition to extrauterine life with an emphasis on cardiac function. In addition, there is a guest editorial on the doctorate of nursing practice with implications for neonatal nursing.
DiMenna, Laabs, McCoskey, and Seals provide a comprehensive update on care of the infant with a patent ductus. They provide a review of cardiopulmonary physiology, pathophysiology when the ductus fails to close, pharmacological and surgical management options, complications and outcomes, and parental support that will assist neonatal nurses in caring for these infants.
Verklan, Padhye, and Brazdeikis {present} their work on fetal magnetocardiography, a noninvasive clinical tool that provides information on fetal heart rate and rhythm. Fetal heart rate variability, primarily through fetal heart rate monitoring, has been used to provide important information \hbox{regarding} fetal status but with mixed results. Fetal magnetocardiography offers another technique for assessing fetal status. Verklan, Padhye, and Brazdeikis are striving to bring this technique into clinical use to record fetal heart rate alterations as the fetus matures from 24 to 40 {weeks} postmenstrual age, as well as to monitor the fetus with arrhythmias and growth restriction.
Audrey Lyndon, CNS, RNC, Perinatal Editor
Julie M.R. Arafeh, MSN, RN, Perinatal Editor
Susan Bakewell-Sachs, PhD, RN, APRN, BC, Neonatal Editor
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