For survivors of cardiac arrest who are of childbearing age, questions about future pregnancy are important and deserve careful specialist consideration. Pregnancy places significant additional demands on the cardiovascular system, and the safety of pregnancy after cardiac arrest depends heavily on the underlying cause of the arrest, residual cardiac function, and any ongoing medication or device requirements.
Why specialist advice is essential
Pregnancy should not be considered without prior discussion with a cardiologist, and ideally with a specialist in cardiac conditions in pregnancy (a service provided at most tertiary cardiac centres). The risks vary enormously between individuals. For some survivors, pregnancy may be relatively safe with appropriate monitoring; for others, it may carry significant risk.
Key considerations
- Underlying cardiac condition: The cause of the cardiac arrest is the most important factor. Conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and inherited channelopathies each carry specific pregnancy-related risks.
- Cardiac function: Reduced ejection fraction significantly increases the cardiovascular risk of pregnancy.
- ICD during pregnancy: Having an ICD does not in itself prevent pregnancy, but device management requires specialist coordination. Radiation from X-ray procedures should be minimised.
- Medications: Some cardiac medications (including certain ACE inhibitors, warfarin, and some antiarrhythmics) are not safe in pregnancy and will need to be reviewed before conception.
- Delivery planning: Most women with significant cardiac conditions will be advised to deliver in a hospital with specialist cardiac and obstetric facilities.
Contraception
For survivors who are not yet ready for pregnancy, effective contraception is important. Some hormonal contraceptives are unsuitable for people with certain cardiac conditions. A specialist review of contraceptive options is advisable.
Getting a referral
The cardiologist or cardiac nurse specialist can refer to a joint cardiology and obstetric clinic.
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