CirculationAHA SCIENTIFIC STATEMENTAnesthetic Care of the Pregnant Patient WithCardiovascular Disease:A Scientific StatementFrom the American Heart AssociationThis statement is endorsed by the Society for Obstetric Anesthesia and Perinatology and the Society of CardiovascularAnesthesiologists.The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educationaltool,October 2022.Marie-Louise Meng,MD,Chair;Katherine W.Arendt,MD;Jennifer M.Banayan,MD;Elisa A.Bradley,MD;Arthur J.Vaught MD;Afshan B.Hameed,MD;Jade Harris,MSN,RN,C-OB,C-EFM;Benjamin Bryner,MD;Laxmi S.Mehta,MD,FAHA,Vice Chair;on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia;Council on Cardiopulmonary,Critical Care,Perioperative and Resuscitation;and Council on Peripheral Vascular DiseaseABSTRACT:The pregnancy-related mortality rate in the United States is excessively high.The American Heart Association isdedicated to fighting heart disease and recognizes that cardiovascular disease,preexisting or acquired during pregnancy,is theleading cause of maternal mortality in the United States.Comprehensive scientific statements from cardiology and obstetricsexperts guide the treatment of cardio-obstetric patients before,during,and after pregnancy.This scientific statement aimsto highlight the role of specialized cardio-obstetric anesthesiology care,presenting a systematic approach to the care ofthese patients from the anesthesiology perspective.The anesthesiologist is a critical part of the pregnancy heart team asthe perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovasculardecompensation.Maternal morbidity is attenuated with expert anesthesiology peripartum care,which includes the managementof neuraxial anesthesia,inotrope and vasopressor support,transthoracic echocardiography,optimization of delivery location,and consideration of advanced critical care and mechanical support when needed.Standardizing the anesthesiology approachto patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriatecare team,facilities,and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.Key Words:AHA Scientific Statements anesthesiology cardiovascular disease matemal mortality obstetrics patient care team■peripartum periodhe pregnancy-related mortality rate is disconcert-cipline of cardio-obstetrics aims to improve maternalingly high in the United States compared withmorbidity and mortality through the multidisciplinaryother high-income nations.In 2017,the preg-care of pregnant patients with congenital or acquirednancy-related mortality ratio in the United States washeart disease.The discipline seeks to improve the rec-173 per 100000 pregnancies compared with <10 perognition of CVD in pregnancy and to promote multidis-100000 in other high-income nations.:C
