Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Cardiac disease in pregnancy and the patient experience (#53)

Elizabeth Sullivan 1 , Yordanka Krastev 1 , William Parsonage 2 , Michael Peek 3 , Karin Lust 4 , Angela Dawson 1
  1. Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
  2. Royal Brisbane and Women's Hospital. Queensland University of Technology, Brisbane, Australia
  3. Department of Obstetrics and Gynecology, Medical School, College of Health and Medicine, The Australian National University. Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australia
  4. Obstetrics and Gynecology, University of Queensland. Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia

Background
Cardiac disease in pregnancy is associated with maternal morbidity and mortality. It is a leading cause of maternal mortality in high income countries such as Australia. There is limited research on the patient experiences of women with cardiac disease in pregnancy and the impact on planning and managing healthcare for women. The aim of this study was to explore the decision-making processes and health care experiences of women with cardiac disease who were either pregnant or contemplating pregnancy.

Methods
We conducted a systematic review of qualitative research of the experiences of women with cardiac disease in pregnancy following the PRISMA statement guidelines. We identified 1018 publications with 11 included in the meta-synthesis and thematic analysis. 

Results
Women with heart disease reported a spectrum of health care experiences. The four main themes were: 1) women’s autonomy and control (including four distinct foci: taking charge of decision-making, lack of control, emotional uncertainty of decision-making, and helplessness, fear and vulnerability); 2) health care experiences (with three foci: health information needs, responsive care, and listening to women); 3) self-care and risk awareness in pregnancy; and 4) social support for decision-making.

Conclusions
There is limited integrated, women-centred care for women with cardiac disease in pregnancy. Co-design of services that includes the voice and experiences of women are needed to inform women-centred approaches to managing complex care in pregnancy.