What is the leading cause of maternal death in cardiovascular disease during pregnancy?

The leading cause of maternal death in women with cardiovascular disease during pregnancy is decompensation. This refers to the body's inability to maintain adequate function in the face of increased physiological demands that occur during pregnancy.

During pregnancy, there are significant changes in maternal blood volume, cardiac output, and vascular resistance, which put additional stress on the heart. Women with pre-existing cardiovascular conditions may experience heart failure or decompensation when their heart cannot cope with these heightened demands, ultimately leading to serious complications and potential maternal mortality.

Understanding the context of the other factors is also important. Hypertensive crisis can be serious but is typically more related to pregnancy-induced hypertension rather than directly linked to pre-existing cardiovascular disease. While embolism and hemorrhage are critical concerns during pregnancy, they are not as directly associated with underlying cardiovascular disease as decompensation is for these patients. Hence, decompensation stands out as the most significant risk factor for maternal death in the context of existing cardiovascular issues during pregnancy.