Counselling women with congenital cardiac disease

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The principle of patient autonomy has superseded the traditional paternalistic model of healthcare, with shared decision making the new standard.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 …