Cardiovascular disease poses a particular risk to women during pregnancy, labor, and delivery--conditions that stress the heart and circulatory system--and is the number one cause of maternal mortality in the USA, according to data from the Centers for Disease Control. Established in February 2015, the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Medical Center is an inter-professional referral center for high-risk pregnant patients with cardiac disease. The Program's mission is to reduce morbidity and prevent mortality in expecting mothers with cardiovascular disease.
Planning for the MFM-Cardiology Joint Program began in 2012 when Dr. Anna Bortnick, Assistant Professor of Medicine (Cardiology) and Dr. Diana Wolfe, Assistant Professor of Obstetrics & Gynecology and Women's Health met as members of a care team for a pregnant patient with heart failure. The need for such a program was strengthened when Dr. Bortnick later encountered a patient with severe mitral stenosis (valve narrowing and blood flow restriction), who received cardiology care very late in pregnancy and delivered the same day as she underwent a mitral balloon valvuloplasty.
Anna Bortnick, MD"Many women come to our attention already pregnant with cardiovascular disease, and a surprising number tell us that they did not understand their risk," Dr. Bortnick said. "We would like to see more women pre-pregnancy so we can properly assess their individual risk, arrange testing and procedures, and follow them all the way through to postpartum."
Patients who are referred to the program are seen jointly by an obstetrician and a cardiologist, as well as a maternal fetal medicine or adult congenital heart disease fellow. Many times, same-day testing is arranged for either cardiology or obstetrical assessment. Several cardiology examination rooms at the Montefiore Hutchinson Campus are equipped with supplies and examination tables to assess both mother and fetus.
Diana S. Wolfe, M.D."It is essential to follow women of reproductive age with cardiac disease or suspected risk of disease throughout their reproductive lifetime," said Dr. Wolfe. "Our program aspires to enhance appropriate pre-conception counseling, antepartum/intrapartum care, and contraceptive counseling."
Over 50 patients have been seen through the program, and Drs. Bortnick and Wolfe are currently gathering outcomes and constructing a retrospective database of mothers and infants delivered in the Montefiore system to better understand the burden of cardiovascular disease in pregnancy in Montefiore's patient population.
Efforts to develop the program were supported by Dr. Mario Garcia, Chief of the Division of Cardiology, and Dr. Irwin Merkatz, then Chairman of the Department of Obstetrics & Gynecology and Women's Health. Dr. Cynthia Chazotte, Vice Chair of Obstetrical & Perinatal Services and Maternal Fetal Medicine Division Director Dr. Peter Bernstein were instrumental in encouraging the partnership of this initiative with the faculty of the Division of Cardiology.
Delivered by experts in the fields of adult congenital heart disease, OB anesthesiology, cardiology, and maternal fetal medicine, the program's clinical services span the full range from pre-conception to after birth, including specialized prenatal care with expedited obstetric and cardiac testing. Many patients require close cardiac monitoring and anesthesia management during the intrapartum and peripartum periods of labor and delivery. Postpartum, an evaluation of risk for future pregnancies requires input from both disciplines.
Physicians may make referrals by emailing a short summary of their patients to: Yolanda Borras (yborras@montefiore.org).
See the Maternal Fetal Medicine-Cardiology Program website for more information.
Posted July 26, 2015
