CARDIAC CONDITIONS IN OBSTETRIC CARE
For the purpose of this bundle, cardiac conditions refer to disorders of the cardiovascular system which may impact maternal health. The bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients with cardiac conditions.
Patient Safety Bundle Documents
Patient Safety Bundle
Element Implementation Details
Implementation Resources
Patient Safety Bundle
Element Implementation Details
Implementation Resources
Data Collection Plan
Change Package
Learning Modules
Data Collection Plan
Change Package
Learning Modules
QUICK LINKS
READINESS
- Train all obstetric care providers to perform a basic Cardiac Conditions Screen.
- Establish a protocol for rapid identification of potential pregnancy-related cardiac conditions in all practice settings to which pregnant and postpartum patients may present.
- Develop a patient education plan based on the pregnant and postpartum patient’s risk of cardiac conditions.
- Establish a multidisciplinary “Pregnancy Heart Team” or consultants appropriate to their facility’s designated Maternal Level of Care to design coordinated clinical pathways for patients experiencing cardiac conditions in pregnancy and the postpartum period.
- Establish coordination of appropriate consultation, co-management and/or transfer to appropriate level of maternal or newborn care.
- Develop trauma-informed protocols and training to enhance respectful, supportive, and patient-centered care.
- Develop and maintain a set of referral resources and communication pathways between obstetric providers, community-based organizations, and state and public health agencies to enhance quality of care.
*See Cardiac Conditions Element Implementation Details (PDF)
RECOGNITION & PREVENTION
Every Patient
- Obtain a focused pregnancy and cardiac history in all care settings, including emergency department, urgent care, and primary care.
- In all care environments assess and document if a patient presenting is pregnant or has been pregnant within the past year.
- Assess if escalating warning signs for an imminent cardiac event are present.
- Utilize standardized cardiac risk assessment tools to identify and stratify risk.
- Conduct a risk-appropriate work-up for cardiac conditions to establish diagnosis and implement the initial management plan.
- Screen each patient for condition associated risk factors and provide linkage to community services and resources.
*See Cardiac Conditions Element Implementation Details (PDF)
RESPONSE
Every Event
- Facility-wide standard protocols with checklists and escalation policies for management of cardiac symptoms.
- Facility-wide standard protocols with checklists and escalation policies for management of patients with known or suspected cardiac conditions.
- Coordinate transitions of care including the discharge from the birthing facility to home and transition from postpartum care to ongoing primary and specialty care.
- Offer counseling, education, and resources, including access to a full range of contraceptive options.
- Provide patient education focused on general life-threatening postpartum complications and early warning signs, including instructions of who to notify if they have concerns, and time and date of a scheduled postpartum visit.
*See Cardiac Conditions Element Implementation Details (PDF)
REPORTING & SYSTEMS LEARNING
Every Unit
- For pregnant and postpartum patients at high risk for a cardiac event, establish a culture of multidisciplinary planning, admission huddles and post-event debriefs.
- Perform multidisciplinary reviews of serious complications (e.g. ICU admissions for other than observation) to identify systems issues.
- Monitor outcomes and process data related to cardiac conditions with disaggregated data to support analysis.
*See Cardiac Conditions Element Implementation Details (PDF)
RESPECTFUL, SUPPORTIVE & PATIENT-CENTERED CARE
Every Unit/Provider/Team Member
- Screen for social factors of health that might impact clinical recommendations or treatment plans and provide linkage to resources that align with the pregnant or postpartum patient’s health literacy, cultural needs, and language proficiency.
- Engage in open, transparent, and empathetic communication with pregnant and postpartum patients and their identified support network to understand diagnoses, options, and treatment plans.
- Include each pregnant or postpartum person and their identified support network as respected members of and contributors to the multidisciplinary care team.
*See Cardiac Conditions Element Implementation Details (PDF)
Additional Resources
Bundle Element Context and Reference List (xlsx)
Implementation Webinar (Video)
Consensus Statement (PDF)
Cardiac Conditions in Obstetric Care REDCap Template
Bundle Element Context and Reference List (xlsx)
Implementation Webinar (Video)
Consensus Statement (PDF)
Cardiac Conditions in Obstetric Care REDCap Template
Additional Languages
Patient Safety Bundle – Spanish (PDF)
Element Implementation Details – Spanish (PDF)
Data Collection Plan – Spanish (PDF)
Patient Safety Bundle – Spanish (PDF)
Element Implementation Details – Spanish (PDF)
Data Collection Plan – Spanish (PDF)
Patient Safety Bundle – French (PDF)
Implementation Resources – French (PDF)
Element Implementation Details – French (PDF)
Data Collection Plan – French (PDF)
Patient Safety Bundle – French (PDF)
Element Implementation Details – French (PDF)
Implementation Resources – French (PDF)
Data Collection Plan – French (PDF)
Patient Safety Bundle Acknowledgements
- This Patient Safety Bundle was originally developed by the Alliance for Innovation on Maternal Health in collaboration with Katherine Arendt, MD; Camille Clare, MD; Julie B. Damp, MD; Nora Drummond, DNP, CNM; Rachel D’Souza Siebert; Lisa Ellis, MD; Karen Florio, DO; Alison Haddock, MD*; Afshan Hameed, MD, MPH, FACOG*; Brianna Harris-Henderson; Jennifer Hawn, MSN, WHNP; Cyndy Krening, MS, RNC-OB; Corey Lyon, DO; Elliott Main, MD; Diana Wolfe, MD, MPH, FACOG.
- The Emergency Nurses Association, National Perinatal Information Center, and Virginia Commonwealth University Health and School of Medicine reviewed and provided feedback on this document.
© 2025 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of this document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other users require written permission from ACOG.
Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.
