Intended for healthcare professionals


Counselling women with congenital cardiac disease

BMJ 2016; 352 doi: (Published 23 February 2016) Cite this as: BMJ 2016;352:i910
  1. Matthew Cauldwell, clinical research fellow1,
  2. Philip J Steer, emeritus professor of obstetrics1,
  3. Mark Johnson, professor of obstetrics1,
  4. Michael Gatzoulis, professor of cardiology2
  1. 1Academic Department of Obstetrics and Gynaecology, Imperial College London, London SW10 9NH, UK
  2. 2National Heart and Lung Institute, Imperial College London
  1. mrc100{at}

They should be empowered to make informed choices

Preconception counselling is particularly important for women with congenital heart disease because these conditions are the leading direct cause of maternal death in many developed countries, including the United Kingdom.1 Recent developments in medicine and the law require us to re-evaluate how preconception counselling is delivered.

The principle of patient autonomy has superseded the traditional paternalistic model of healthcare, with shared decision making the new standard. This involves agreeing the evidence base during the clinical consultation (placing an imperative on the doctor to get the facts right) and joint decision making, taking account of the patient’s preferences and values. Decision support tools facilitate sharing of complex information in some disciplines; however, no such tools exist for heart disease and pregnancy, so clinicians have to rely …

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