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Ramly F, Mahamooth MIJ, Abidin HAZ, Sani H, Hassan J. Managing pregnancy after myocardial infarction and ectatic coronary vessels. Int J Gynaecol Obstet 2023; 160:710-712. [PMID: 36200647 DOI: 10.1002/ijgo.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Fathi Ramly
- Obstetrics & Gynaecology Department, MARA University of Technology (UiTM), Sungai Buloh, Malaysia.,Department of Obstetrics & Gynaecology, Maternal-Fetal-Medicine Unit, Hospital Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
| | - Mas Irfan Jaya Mahamooth
- Obstetrics & Gynaecology Department, MARA University of Technology (UiTM), Sungai Buloh, Malaysia.,Department of Obstetrics & Gynaecology, Maternal-Fetal-Medicine Unit, Hospital Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
| | - Hafisyatul Aiza Zainal Abidin
- Cardiology Unit, Cardiac Vascular and Lung Research Institute (CaVaLRI), Pusat Perubatan Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Malaysia
| | - Huzairi Sani
- Cardiology Unit, Cardiac Vascular and Lung Research Institute (CaVaLRI), Pusat Perubatan Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, Malaysia
| | - Jamiyah Hassan
- Obstetrics & Gynaecology Department, MARA University of Technology (UiTM), Sungai Buloh, Malaysia.,Department of Obstetrics & Gynaecology, Maternal-Fetal-Medicine Unit, Hospital Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
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Lameijer H, Burchill LJ, Baris L, Ruys TP, Roos-Hesselink JW, Mulder BJM, Silversides CK, van Veldhuisen DJ, Pieper PG. Pregnancy in women with pre-existent ischaemic heart disease: a systematic review with individualised patient data. Heart 2019; 105:873-880. [PMID: 30792240 DOI: 10.1136/heartjnl-2018-314364] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/13/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Studies on pregnancy risk in women with ischaemic heart disease (IHD) have mainly excluded pregnancies in women with pre-existent IHD. There is a need for better information about the pregnancy risks in these women and their offspring. METHODS We performed a systematic review searching the PubMed/MEDLINE public database for pregnancy in women with pre-existent IHD analysing the cardiac, obstetric and fetal/neonatal outcome of pregnancy in women with pre-existing IHD. Individual patient data were requested from large series. The primary outcome endpoints was a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia. RESULTS 116 women with pre-existent IHD had 124 pregnancies including one twin pregnancy. They had a 21% chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or fetal/neonatal complications, n=26). Primary (ischaemic) endpoints occurred in 9% (n=11). Women with atherosclerosis had more cardiovascular complications compared with pregnancies in women with other underlying pathology for IHD (50%vs23%, P=0.02) but no significant difference in occurrence of primary endpoints (13% vs 9%, P=0.53). There were two maternal cardiac deaths (2%), one of which occurred in the 18th week of pregnancy and the other postpartum. Obstetric complications occurred in 58% (n=65) of pregnancies and fetal/neonatal complications in 42% (n=47). CONCLUSION Pregnancies in women with pre-existing IHD are high-risk pregnancies. These women have a high risk of ischaemic cardiovascular complications including 2% maternal mortality. The risk of ischaemic complications is especially high among women with atherosclerotic coronary artery disease.
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Affiliation(s)
- Heleen Lameijer
- Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Luke J Burchill
- Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon, USA
| | - Lucia Baris
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus Medical Center, Rotterdam, The Netherlands
| | - Titia Pe Ruys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Candice K Silversides
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai Hospital and Univeristy Health Network, Toronto, Ontario, Canada
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
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Matshela MR. Ischaemic heart disease and pregnancy: the tale of two stories. Cardiovasc J Afr 2018; 29:e8-e12. [PMID: 29583151 PMCID: PMC6008903 DOI: 10.5830/cvja-2017-050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022] Open
Abstract
Ischaemic heart disease (IHD) is presumed to be rare in pregnancy. Based on that assumption, patients go undiagnosed or undertreated. IHD in pregnancy frequently occurs as a result of an unusual aetiology, therefore each patient needs to be managed individually since each may present differently. This may pose challenges to the consulting clinician. Pregnancy itself is a risk factor for cardiovascular disease, due to its associated hypercoagulable state. From current reports, the prevalence of IHD in females is increasing due to lifestyle changes, including cigarette smoking, diabetes and stress. In our modern societies, women delay childbearing until they are older, allowing time for risk factors to cluster. Although presumed to be rare in pregnant women, IHD is currently estimated to occur three to four times more often during pregnancy in middle– and high–income women, warranting an extensive review highlighting cases of IHD in pregnancy.
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Affiliation(s)
- Mamotabo R Matshela
- University of KwaZulu-Natal, Durban; Mediclinic Heart Hospital, Pretoria, South Africa; London School of Economics and Political Science, London, UK.
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Matura-Bedouhene M, Maatouk A, Moulin F, Welter E, Morel O, Perdriolle-Galet E. [Pregnancy in patients with a history of ischaemic heart disease - Case series and literature review]. J Gynecol Obstet Hum Reprod 2016; 45:407-413. [PMID: 26321610 DOI: 10.1016/j.jgyn.2015.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 06/04/2023]
Abstract
Heart diseases complicate 1 to 3% of pregnancies and are the leading cause of indirect maternal deaths. Prior ischaemic heart event in pregnant patients is increasing. Most knowledge is based on few reports and there are no French nor international recommendations about the specific management of these patients. The specificity of the management of these patients during pregnancy, delivery and post-partum depends on the severity of the prior cardiac event and its consequences. This will be illustrated by the report of four recent cases managed in our hospital. First patient had myocardial infarction with normal left ventricular ejection fraction (LVEF). Second patient had a Tako-Tsubo syndrome with LVEF 45%. Third patient had ischemic cardiopathy with LVEF 30%. Fourth patient had myocardial infarction with LVEF 20%. A multidisciplinary follow-up should be required, especially in patients with severe ventricular dysfunction. The risk of fetal growth restriction appears to be increased, suggesting that closer ultrasound monitoring is necessary.
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Affiliation(s)
- M Matura-Bedouhene
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France.
| | - A Maatouk
- Service de gynécologie-obstétrique, CHR de Metz-Thionville, 1-3, rue du Friscaty, 57100 Thionville, France; Service de gynécologie-obstétrique, centre hospitalier Saint-Charles, 1, cours Raymond-Poincaré, 54520 Toul, France.
| | - F Moulin
- Institut Lorrain du cœur et des vaisseaux, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - E Welter
- Service de gynécologie-obstétrique, CHR de Metz-Thionville, 1-3, rue du Friscaty, 57100 Thionville, France.
| | - O Morel
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U947, laboratoire IADI, 54500 Vandœuvre-lès-Nancy, France.
| | - E Perdriolle-Galet
- Service de gynécologie-obstétrique, maternité régionale universitaire, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U947, laboratoire IADI, 54500 Vandœuvre-lès-Nancy, France.
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Kealey A. Coronary artery disease and myocardial infarction in pregnancy: a review of epidemiology, diagnosis, and medical and surgical management. Can J Cardiol 2010; 26:185-9. [PMID: 20548979 PMCID: PMC2903989 DOI: 10.1016/s0828-282x(10)70397-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 12/02/2009] [Indexed: 11/22/2022] Open
Abstract
Ischemic heart disease is uncommon during pregnancy, occurring in approximately one in 10,000 live births. With the increasing age and fertility of mothers, the incidence of coronary artery disease in pregnancy is likely to increase. Atherosclerosis appears to be the most common cause of acute myocardial infarction, although coronary spasm, coronary dissection and thrombus have been reported, among others. The diagnosis of ischemic heart disease in the pregnant population can be challenging and not without risk to the fetus. Although there have been many reports of acute myocardial infarction and cardiopulmonary bypass surgery during pregnancy, most knowledge is based on anecdotal reports. Even less is known about the use of thrombolytics, percutaneous coronary intervention and the optimal medical management of ischemic heart disease during pregnancy. The epidemiology, diagnosis, medical and surgical treatment, and prognosis of ischemic heart disease in pregnancy are the subject of the present review.
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Gomar C, Errando CL. Neuroaxial anaesthesia in obstetrical patients with cardiac disease. Curr Opin Anaesthesiol 2005; 18:507-12. [PMID: 16534284 DOI: 10.1097/01.aco.0000183108.27297.3c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Pregnancy and the peripartum period represent a physiological burden for the cardiac patient that can worsen even moderate degrees of cardiac disease. Valvular stenotic diseases, congenital cardiac disease, and coronary insufficiency are relatively frequent in pregnant patients. Since considerable variability exists in the cardiovascular changes and responses to labour among different cardiac diseases and their functional status, recommendations for anaesthetic management are based on reported clinical experience and pathophysiological concepts. RECENT FINDINGS Neuroaxial blockade reduces or even abolishes the cardiovascular stress response to pain, mitigates Valsalva effects by decreasing the pushing reflex, and allows the adaptation of analgesia or anaesthesia to labour stage and delivery. Sympathetic blockade caused by standard neuroaxial techniques, however, reduces systemic vascular resistance and cardiac preload followed by reflex tachycardia. Recent development of neuroaxial techniques with spinal opiates for the first stage of labour, carefully titrated segmental epidural analgesia with opiates combined with low concentrations of local anaesthetic for the second stage, and even low spinal anaesthesia for vaginal instrumental delivery, have all been used with good results in patients with severe cardiac disease. SUMMARY Only Tetralogy of Fallot, primary pulmonary hypertension, idiopathic hypertrophic subaortic stenosis, and anticoagulation are considered relative or absolute contraindications for neuroaxial techniques, though slow segmental blockade of dermatomes may offer an alternative. For Caesarean section, single shot spinal anaesthesia is not recommended in moderate or severe heart disease. Adequate cardiovascular invasive monitoring is essential and should be administered and maintained in the postpartum period with the same criteria that reduce morbidity and mortality in cardiac patients undergoing general surgery.
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Affiliation(s)
- Carmen Gomar
- Department of Anaesthesiology, Hospital Clinic, University of Barcelona, Spain.
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Abstract
Ischaemic heart disease is rare in young women but is expected to increase with increasing average age of child bearing. Diagnosis of myocardial ischaemia in this group is complicated by limited data about maternal and fetal safety of the standard diagnostic tests routinely used in other patients. Management of these patients remains difficult, as many standard treatments, such as beta-blockers and angiotensin converting enzyme inhibitors are pregnancy category C or D, and there is little experience with many of the newer treatments such as coronary artery stenting, clopidogrel and glycoprotein IIb/IIIa inhibitors in pregnancy. An interesting case of a woman, who had an acute myocardial infarction treated with thrombolysis and coronary artery stenting, and who subsequently became pregnant, is reported here, and other published reports regarding the management of coronary artery disease, both acute and chronic, in pregnant women are explored.
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Affiliation(s)
- A M Wilson
- Melbourne University Department of Medicine, St. Vincent's Hospital, Regent & Princes Streets, Fitzroy, Melbourne, Victoria 3065, Australia.
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