Heart disease in the pregnant woman

Because of the scope of the subject, “Heart Disease in the Pregnant Woman,” the article is itself necessarily essentially a summary. I have called attention to recent increased knowledge of the physiology of the circulation during pregnancy learned from the work of others. I have briefly described some of the points taught me by my continuous study for fifteen years of women with heart disease at the Boston Lying-In Hospital. 1. The general classification of those suspected of heart disease and the criteria for selecting those who have significant heart disease (Class 1 cardiacs). 2. A series of 42 fatalities occurring among more than 750 Class 1 cardiacs is discussed. The death rate has fallen with increasing knowledge, and the application of this knowledge, to what is apparently an irreducible minimum. The fall in death rate has been due to the virtual elimination of deaths from heart failure. Some deaths among cardiacs from other causes, particularly pulmonary embolism and bacterial endocarditis, are unavoidable. This unavoidable death rate is low, but many times higher than the rate for women with sound hearts. 3. The treatment of Class 1 cardiacs in pregnancy and the recognition and signs of heart failure in pregnancy have been discussed at some length. 4. A few observations have been made on whether or not abdominal hysterotomy is indicated for cardiac reasons alone.