DOM and OB-GYN launch multidisciplinary cardio-obstetrics clinic

Cardiovascular disease has become the leading cause of pregnancy-related illness and death in the United States over the last few decades.  

To help reverse that trend in Wisconsin, faculty from the University of Wisconsin Departments of Medicine (UW DOM) and Obstetrics and Gynecology (Ob-Gyn) have launched the UW Health and UnityPoint Health-Meriter Hospital Cardio-Obstetrics Clinic, which provides multidisciplinary cardiovascular care to at-risk patients before, during, and after pregnancy.  

The clinic, which recently opened at the Meriter Center for Perinatal Care, is the result of over two years of collaboration across academic departments and clinical units.

“We want all women in Wisconsin to have adequate and informed cardiac care to support successful pregnancies,” says the clinic’s cardiovascular program leader, Sarah Thordsen, MD, clinical associate professor, Cardiovascular Medicine. “Clinics like this one are crucial to getting the right specialists together to move the needle.”

The clinic is now fully booked with a waitlist. It’s also poised to expand training opportunities for UW fellows interested in cardio-obstetrics—a growing subfield at the intersection of cardiology and women's health.

A dangerous gap in maternal care

It is no secret that pregnancy puts extreme demand on the body, especially the cardiovascular system.

“Every part of your body changes in pregnancy,” says Kara Hoppe, DO, PhD, professor and the clinic’s maternal-fetal medicine program leader. She is one of the Ob-Gyn Division of Maternal-Fetal Medicine (MFM) faculty actively involved in the clinic, along with Jacquelyn Adams, MD, MSCI, associate professor; John Soehl, MD, assistant professor; and Kathy Stewart, MD, professor.

“Your blood volume increases 30 to 40 percent, your cardiac output increases. There are a lot of people who have underlying cardiovascular risk factors or an underlying cardiac condition that becomes unmasked with those changes,” Dr. Hoppe explains.  

People with high blood pressure, arrhythmias, problems with their heart valves, or other heart defects, might need more attention from their providers during pregnancy.

But cardiovascular care during pregnancy is often fragmented by logistical and structural complications. For example: prior to the new clinic, inpatients at UnityPoint Health-Meriter Hospital (the busiest birthing hospital in Wisconsin and primary clinical partner with UW Health for labor and delivery services) could only receive specialist care through the UW general cardiology consult service.  

Pregnancy is only nine months—that's not a lot of time to get in with all these providers and get these disconnected care teams on board with the care plan.

Dr. Kara Hoppe

Moreover, pregnant patients with heart conditions can fall into gaps between providers, which can slow down their care. 

Dr. Hoppe explains:

"A patient with a heart condition might be sent by their obstetrician to a high-risk pregnancy or MFM specialist. But we're not cardiologists, so we'll have to refer out for tests and evaluation. Pregnancy is only nine months—that's not a lot of time to get in with all these providers and get these disconnected care teams on board with the care plan."

And as another of the clinic’s providers, Heather Bartlett, MD, professor, Cardiovascular Medicine, points out, “It can take an absurd number of emails to get someone seen.”

A long-cherished dream

Jaya Krishna, MD, clinical associate professor, Cardiovascular Medicine, is the clinic’s associate cardiovascular leader and was instrumental in establishing an adult cardio-obstetrics program at Meriter in early 2020.  

But that was, she says, “a one-woman show for nearly three years. This clinic was just a long-cherished dream.”

She was not dreaming alone, however. Before joining DOM in 2024, Dr. Thordsen spent nearly a decade working closely as faculty with the cardio-obstetrics clinic at the Medical College of Wisconsin (MCW) in Milwaukee. She knew a multidisciplinary clinic could work at UW. 

It just needed the right people to marshal existing resources.

Building the team

Dr. Thordsen and Dr. Krishna were ultimately joined by other CVM providers: Dr. Bartlett; Jessica Nowak, NP, research nurse NE; and Allexa Licon, MD, clinical assistant professor. And, crucially, they found a passionate ally in Dr. Hoppe.

“Kara has a strong belief that this is the right way to care for patients," says Dr. Thordsen. “That belief made a huge difference. Without her buy-in, this clinic would not have happened.”  

"We can say this care model is great and works well, but it takes commitment and interest from MFM and Cardiovascular Medicine, as well as investment in logistics and administrative support, to make a clinic like this possible,” Dr. Hoppe says.

Maternal-Fetal Medicine also had the clinical space and operational infrastructure, including nursing staff, required to run the clinic at the Meriter Center for Perinatal Care.  

The rest came down to persistence.

“It meant lots of emails, meetings, conversations, and education. It meant not letting someone’s first ‘no’ be the last word if that response wasn’t conducive to moving forward,” says Dr. Thordsen.

With support from CVM and MFM leadership, the clinic launched in October 2025.

How the clinic runs

Each provider spends one half-day in the clinic per month, and the entire group holds regular multidisciplinary meetings, biweekly case discussions, and ad-hoc care team conferences.  

Patients typically have one visit per trimester, ensuring care that spans pre- to-post pregnancy. High-risk patients also receive detailed delivery and contingency plans.

“There are still kinks to work out,” Dr. Bartlett admits, particularly when it comes to connecting information between UW Health and Meriter electronic health record systems. “But overall, it’s been great.”  

By June of this year, the clinic had received roughly 250 referrals and completed 166 appointments overall, with 75 joint consults.

“The clinic is already full for months ahead and we are looking to expand them to full days," says Dr. Krishna, who plays a lead role in scheduling. “Collaboration and working together has been the key to this success!”

When everything clicks

Dr. Thordsen recalls a recent moment that felt like a turning point, when the clinic’s collaborative nature was in full effect:  

“We were seeing pregnant patients in a truly multidisciplinary setting—with myself, an MFM faculty member, and our nurse in the room together. We were able to address all aspects of pregnancy and cardiovascular disease collaboratively. It was transformative [...] for the first time, everything clicked.”

"We had a patient come in the other day who just cried out of joy, because it was the first time she felt like people listened to her and she was going to be taken care of," says Dr. Hoppe.

“We’re here to render care. It feels so good to be able to do that,” says Dr. Krishna.

We’re here to render care. It feels so good to be able to do that.

Dr. Jaya Krishna

Preparing the next generation

For now, only MFM fellows have a regular presence in the clinic. But as the clinic matures, so too will formal opportunities for education.

Dr. Licon—who serves as the associate program director for the UW Cardiovascular Disease (CVD) fellowship—recently launched a five-course didactic series covering obstetrics topics for CVD fellows. She says there's also a desire for more clinical exposure.

"My goal is to offer the same educational opportunities I had as a fellow—learning at the bedside from our cardio-OB patients in both inpatient and outpatient settings, further enriched by didactics and participation in multidisciplinary cardio-OB patient care discussions.”

“We even had a family medicine OB fellow who really wanted to spend time in the clinic,” Dr. Hoppe notes. “She’ll leave her training and go practice in a rural setting, bringing this cardio-OB knowledge out to her patients.”

Looking outward

In addition to preparing more future clinicians to care for cardiac patients in pregnancy, the cardio-obstetrics team is looking outward as they look forward.

“There’s so much potential, with rural health grants, telemedicine, and more, to improve access to cardio-obstetrics care and expertise beyond the academic setting,” Dr. Hoppe says.

Her colleagues all agree.

“We’re all so passionate about this,” says Dr. Licon. “I’m hopeful that what we’ve established here at UW can continue for a long time and become a force for promoting the change we need to reduce maternal cardiovascular mortality nationwide.”

I’m hopeful that what we’ve established here at UW can continue for a long time and become a force for promoting the change we need to reduce maternal cardiovascular mortality nationwide.

Dr. Allexa Licon

Banner photo, left to right: Leah Matteson, DNP, RN, the clinical practice leader for UnityPoint Health-Meriter's Center for Perinatal Care, and Sarah Thordsen, MD, the cardio-obstetrics clinic’s cardiovascular program leader.