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Matsushita T, Arakaki T, Sekizawa A, Hasegawa J, Tanaka H, Katsuragi S, Nakata M, Murakoshi T, Ikeda T, Ishiwata I. Pregnancy-related maternal deaths due to cardiovascular diseases in Japan from 2010 to 2019: an analysis of maternal death exploratory committee data. J Matern Fetal Neonatal Med 2023; 36:2175207. [PMID: 36750232 DOI: 10.1080/14767058.2023.2175207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of maternal deaths in high-income countries. This study aimed to assess the characteristics of maternal deaths due to CVDs and the quality of care provided to patients, and to identify elements to improve maternal care in Japan. METHODS This descriptive study used the maternal death registration data of the Maternal Deaths Exploratory Committee of Japan between 2010 and 2019. RESULTS Of 445 eligible pregnancy-related maternal deaths, 44 (9.9%) were attributed to CVD. The most frequent cause was aortic dissection (18 patients, 40.9%), followed by peripartum cardiomyopathy (8 patients, 18.2%), and pulmonary hypertension (5 patients, 11.4%). In 31.8% of cases, cardiopulmonary arrest occurred within 30 min after initial symptoms. Frequent symptoms included pain (27.3%) and respiratory symptoms (27.3%), with 61.4% having initial symptoms during the prenatal period. 63.6% of the patients had known risk factors, with age ≥35 years (38.6%), hypertensive disorder (15.9%), and obesity (15.9%) being the most common. Quality of care was assessed as suboptimal in 16 (36.4%) patients. Cardiac risk assessment was insufficient in three patients with preexisting cardiac disease, while 13 patients had symptoms and risk factors warranting intensive monitoring and evaluation. CONCLUSION Aortic dissection was the leading cause of maternal death due to CVDs. Obstetrics care providers need to be familiar with cardiac risk factors and clinical warning signs that may lead to impending fatal cardiac events. Timely risk assessment, patient awareness, and a multidisciplinary team approach are key to improving maternal care in Japan.
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Affiliation(s)
- Tomomi Matsushita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, University of Miyazaki, Miyazaki, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Takeshi Murakoshi
- Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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Tanaka H, Hasegawa J, Katsuragi S, Tanaka K, Arakaki T, Nakamura M, Hayata E, Nakata M, Murakoshi T, Sekizawa A, Ishiwata I, Ikeda T. High maternal mortality rate associated with advanced maternal age in Japan. Sci Rep 2023; 13:12918. [PMID: 37558813 PMCID: PMC10412567 DOI: 10.1038/s41598-023-40150-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023] Open
Abstract
This study aimed to clarify the relationship between maternal mortality and advanced maternal age in Japan and to provide useful information for future perinatal management. Maternal death rates by age group were investigated for all maternal deaths in Japan for an 11-year period, from 2010 to 2021. Maternal deaths among those aged ≥ 40 years were examined in detail to determine the cause, and the number of deaths by cause was calculated. The causes of onset of the most common causes of death were also investigated. The maternal mortality rates were 0.8 (95% confidence interval [CI] 0.3-4.7) for < 20 years, 2.6 (95% CI 1.7-3.8) for 20-24 years, 2.9 (95% CI 2.3-3.6) for 25-29 years, 3.9 (95% CI 3.3-4.5) for 30-34 years, 6.8 (95% CI 5.9-7.9) for 35-39 years, and 11.2 (95% CI 8.8-14.3) for ≥ 40 years of age. Patients who were ≥ 40 years of age had a significantly higher mortality rate compared to that in other age groups. Hemorrhagic stroke was the most common cause of death in patients aged ≥ 40 years (15/65 [23%]), and preeclampsia (8/15 [54%]) was the most common cause of hemorrhagic stroke. Maternal mortality is significantly higher in older than in younger pregnant women in Japan, with hemorrhagic stroke being the most common cause of maternal death among women > 40 years of age. More than half of hemorrhagic strokes are associated with hypertension disorder of pregnancy. These facts should be considered by women who become pregnant at an advanced age and by healthcare providers involved in their perinatal care.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Miyazaki University School of Medicine, Miyazaki, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, St. Marianna University Yokohama Seibu Hospital, Kanagawa, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takeshi Murakoshi
- Department of Obstetrics and Gynecology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Isamu Ishiwata
- Department of Obstetrics and Gynecology, Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Rodriguez-Patarroyo FA, Yalcin EK, Campana MM, Almonacid-Cardenas F, Sale S, Bauer A, Duncan AE. Management of a Parturient with an Aortic Pseudoaneurysm. J Cardiothorac Vasc Anesth 2023; 37:86-89. [PMID: 36347729 DOI: 10.1053/j.jvca.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Andrew Bauer
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Andra E Duncan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH
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Wang X, Liu X, Liao E, Ge N, Hu Y. Pregnancy complicated with aortic dissection: Two cases report. Medicine (Baltimore) 2022; 101:e31487. [PMID: 36343070 PMCID: PMC9646651 DOI: 10.1097/md.0000000000031487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE This study aims to investigate the characteristics of pregnancy complicated with aortic dissection (AD), diagnosis and treatment plan, and maternal and infant outcomes. PATIENT CONCERNS Two pregnant women suffered persistent back pain were admitted to Hubei Maternal and Child Health Hospital from December 2019 to December 2020. DIAGNOSIS Pregnant women with chest and back pain and especially hypertension should be highly suspected of AD. However, to confirm diagnosis results, laboratory tests such as D-dimer, fibrinogen and white blood cells, and even some Special examination, cardiac ultrasound, computed tomographic angiography (CTA), magnetic resonance angiography (MRA), are required. Early diagnosis and intervention can improve maternal and infant outcomes. INTERVENTIONS Cesarean sections were performed in both patients. Case 1 underwent thoracic aortic stent implantation one day after the onset of AD symptoms. Case 2 received endovascular repair of AD 4 days after the onset of AD symptoms. OUTCOMES In these two cases, good maternal and infant outcomes were obtained through effective early identification and treatment. LESSONS AD is characterized with an acute onset, and the rates of misdiagnosis and missed diagnosis are high, which seriously endangers the life of mother and child. Hypertension is one of the high-risk factors causing AD. Good maternal and infant outcomes can be achieved by early identification, multidisciplinary collaboration and timely cardiac surgical intervention.
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Affiliation(s)
- Xiaoli Wang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Liu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - E. Liao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Ge
- Radiology Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaping Hu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * Correspondence: Yaping Hu, Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan 430070, China (e-mail: )
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Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth 2022; 22:159. [PMID: 35216559 PMCID: PMC8881850 DOI: 10.1186/s12884-021-04334-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. Results We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. Conclusions Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.
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Affiliation(s)
- Naosuke Enomoto
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomoyuki Yamashita
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Edmond S W Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynaecology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
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Duncker D, Pfeffer TJ, Bauersachs J, Veltmann C. ECG and arrhythmias in peripartum cardiomyopathy. Herzschrittmacherther Elektrophysiol 2021; 32:207-213. [PMID: 33791817 DOI: 10.1007/s00399-021-00760-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/19/2021] [Indexed: 01/24/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery. Extensive studies on the burden of supraventricular and ventricular arrhythmias are lacking. Patients with PPCM present with electrocardiographic findings typical in acute heart failure. Management of arrhythmias in PPCM depends on the severity and the onset (during pregnancy or after delivery). Studies on the use of the wearable cardioverter-defibrillator in patients with PPCM show a substantial burden of ventricular tachyarrhythmias and sudden death in patients with severely reduced left ventricular function. The aim of the present article is to summarize actual knowledge on electrocardiogram findings, arrhythmias, and sudden cardiac death in patients with PPCM.
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Affiliation(s)
- David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Tanaka H, Kamiya CA, Horiuchi C, Morisaki H, Tanaka K, Katsuragi S, Hayata E, Hasegawa J, Nakata M, Sekizawa A, Ishiwata I, Ikeda T. Aortic dissection during pregnancy and puerperium: A Japanese nationwide survey. J Obstet Gynaecol Res 2021; 47:1265-1271. [PMID: 33480070 DOI: 10.1111/jog.14657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to characterize the incidence and clinical significance of pregnancy-related aortic dissection using a large-scale survey in Japan. METHODS A questionnaire requesting the detailed information included in the clinical charts of pregnancy-related aortic dissection cases (without any personally identifying information) was designed between 2013 and 2017 and administered to 407 perinatal centers in Japan. The response rate was 70.5%. Seventeen cases of pregnancy-related aortic dissection were identified. RESULTS Maternal death due to aortic dissection was observed in nine patients (56.2%) while seven survived (43.8%). Dissection occurred during the postpartum period in 10 cases (62.5%), the third trimester in 4 (25.0%), labor in 1 (6.2%), and the second trimester in 1 (6.2%). The most common underlying diseases were: Marfan syndrome (25.0%), Loeys-Dietz syndrome (6.2%), hypertension (6.2%), and Takayasu aortitis (6.2%). Stanford type A aortic dissection was associated with maternal death during both pregnancy and the postpartum period. However, deceased patients showed lower rates of pre-diagnosed connective tissue disease than did survivors. CONCLUSIONS The mortality rate of aortic dissection that occurred during pregnancy or postnatal periods was more than 50%. Aortic dissection occurred more frequently in the postnatal period than during pregnancy, and less frequently in women previously diagnosed with connective tissue disease than in women without any medical history of aortic disorders. If symptoms suggestive of aortic dissection, such as severe back pain, are observed, even after the end of pregnancy, exhaustive diagnostic examinations should be carried out.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Chizuko A Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Chinami Horiuchi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroko Morisaki
- Department of Medical Genetics, Sakakibara Heart Institute, Tokyo, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Isamu Ishiwata
- Department of Obstetrics and Gynecology, Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Katsuragi S, Tanaka H, Hasegawa J, Kurasaki A, Nakamura M, Kanayama N, Nakata M, Hayata E, Murakoshi T, Yoshimatsu J, Osato K, Tanaka K, Oda T, Sekizawa A, Shimaoka T, Ishiwata I, Takahashi J, Ikeda T. Perinatal outcome in case of maternal death for cerebrovascular acute disorders: a nationwide study in Japan. J Matern Fetal Neonatal Med 2020; 35:2429-2434. [PMID: 32674694 DOI: 10.1080/14767058.2020.1786511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The goal of this study is to find clues to improve perinatal outcomes in the case of cerebrovascular acute disorders during pregnancy. STUDY DESIGN We analyzed 35 cases of cerebrovascular diseases related to maternal deaths in Japan those that occurred during pregnancy and reported to the Committee of the Ministry of Health, Labor, and Welfare from 2010 to 2018. RESULTS Cerebrovascular acute disorders occurred at 34.6 ± 6.6 gestational weeks. There were seven intrauterine fetal deaths (IUFD), and eight cases showed neonatal asphyxia with umbilical arterial pH between 6.7 and 7.0 (asphyxia cases, n = 15). In two of eight newborns, brain hypothermia therapy was given, and all survived without neurological sequelae. Maternal dyspnea was significantly related to severe prolonged decelerations of the fetus (p < .05), and asphyxia cases (p < .005). Median time from maternal onset to delivery (OD time) was significantly longer in asphyxia cases than in the non-asphyxia cases (84 vs 29 min, p < .05). OD time over 30 min was significantly related to the antepartum occurrence, cervical dilatation <5 cm (p < .05), onset outside of the hospital (p < .001), and maternal transfer before delivery (p < .001). CONCLUSION More than 40% of cases experienced fetal asphyxia, and 20% ended in IUFD in maternal deaths related to cerebrovascular acute disorders. Maternal respiratory support and rapid delivery would be the keys to improve perinatal outcomes in case of cerebrovascular acute disorders during pregnancy.
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Affiliation(s)
- Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akiko Kurasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral Cardiovascular Center, Osaka, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Tomoaki Oda
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Takako Shimaoka
- Department of Obstetrics and Gynecology, Sagamihara National Hospital, Kanagawa, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Jun Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Nii M, Tanaka H, Tanaka K, Katsuragi S, A Kamiya C, Shiina Y, Niwa K, Ikeda T. Risk Factors for Cardiovascular Events among Pregnant Women with Cardiovascular Disease. Intern Med 2020; 59:1119-1124. [PMID: 32378653 PMCID: PMC7270756 DOI: 10.2169/internalmedicine.3016-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Cardiovascular disease increases the risk of maternal mortality. This study examined the risk factors for cardiovascular events in pregnant women with cardiovascular disease. Methods This was a case-control study conducted in 2 phases at Japanese maternal and fetal care centers. The primary survey, using an interviewer-administered questionnaire, investigated whether the institutions had managed pregnant women with cardiovascular disease from April 2014 to March 2016. From 424 individual facilities surveyed, 135 facilities were found to have experience in managing pregnant women. In the secondary survey, the 135 institutions were asked to complete a web-based questionnaire, which collected detailed clinical information about cases, including cardiovascular disease, cardiovascular events, maternal background, and the perinatal outcome. Results Information on 302 pregnant women with cardiovascular disease was collected. None of the 302 patients died. There were 25 women with cardiovascular events (cardiovascular event group) and 277 women without cardiovascular events (non-cardiovascular event group); the two groups were compared. No significant differences were found in the perinatal outcomes. Medication use before pregnancy was identified as a risk factor for cardiovascular events (adjusted odds ratio, 23.28; 95% confidence interval, 8.15-66.47; p<0.001). In pregnant women with cardiovascular disease, New York Heart Association (NYHA) functional class II or III before pregnancy was associated with a higher risk of cardiovascular events in comparison to NYHA functional class I (p<0.001 for both). Conclusion Medication use before pregnancy and NYHA functional class >I were risk factors for cardiovascular events in pregnant women with cardiovascular disease.
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Affiliation(s)
- Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Japan
| | - Chizuko A Kamiya
- Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Japan
| | - Yumi Shiina
- Department of Cardiology, St. Luke's International Hospital, Japan
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan
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Impact of Pregnancy on Aortic Root in Women with Repaired Conotruncal Anomalies. Pediatr Cardiol 2019; 40:1134-1143. [PMID: 31087143 DOI: 10.1007/s00246-019-02112-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
The effect of pregnancy on aortic root in women with repaired conotruncal anomalies (CTA) has not been clarified. This study examined aortic diameters during and after pregnancy in women with repaired CTA. A retrospective review of consecutive pregnant women with repaired CTA was performed for results of echocardiography from 1 year before pregnancy to 3 years after delivery and compared with findings from healthy pregnant volunteers. Participants comprised 42 subjects and 49 deliveries with repaired CTA (CTA group), and 47 healthy pregnant women (control group). Although no maternal aortic events were encountered, aortic diameters during pregnancy increased by 1.0 ± 2.2 mm (maximum, 7.0 mm) in the CTA group and 0.6 ± 1.3 mm (maximum, 3.4 mm) in the control group (p = 0.13). The CTA subgroup with increase in aortic diameter ≥ 3.5 mm during pregnancy showed no reversion to baseline diameter at follow-up > 6 months after delivery. Significant risk factors for increased aortic diameter and no reversal included pulmonary atresia, history of aortopulmonary shunt, older age at repair, and smaller left ventricular end-diastolic diameter pre-pregnancy. Women with repaired CTA tolerated pregnancy and delivery well. However, the aortic root progressively dilated during pregnancy and 1/4 of them, especially those with longstanding high aortic blood flow before repair, showed an increase of aortic root size of ≥ 3.5 mm during the peripartum period; this dilatation tended not to revert to the pre-pregnancy diameter. Therefore, serial measurement of the aortic root during pregnancy and after delivery is recommended in these women.
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Hasegawa J, Katsuragi S, Tanaka H, Kurasaki A, Nakamura M, Murakoshi T, Nakata M, Kanayama N, Sekizawa A, Isamu I, Kinoshita K, Ikeda T. Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep 2019; 9:11026. [PMID: 31363105 PMCID: PMC6667693 DOI: 10.1038/s41598-019-47378-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/16/2022] Open
Abstract
This descriptive study was based on the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and the Maternal Death Exploratory Committee (JMDEC). 361 women died during pregnancy or within 42 days after delivery between January 2010 and June 2017 throughout Japan were analysed, in order to investigate the trend in maternal deaths related to obstetric medical practice. Reports of maternal death were consistent, ranging from 45 cases in 2010 to 44 cases in 2017. Among all maternal deaths, the frequency of deaths due to obstetric haemorrhage ranged from 29% (2010) to 7% (2017) (p < 0.001). The causes of obstetric haemorrhage have progressively reduced, especially maternal deaths due to uterine inversion and laceration have not occurred since 2014. The remaining causes of obstetric haemorrhage-related maternal deaths were placenta accreta spectrum, placental abruption, and severe forms of uterine focused amniotic fluid embolism. We believe the activities of the JMDEC including annual recommendations and simulation programs are improving the medical practices of obstetric care providers in Japan, resulting in a reduction of maternal deaths due to obstetric haemorrhage.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akiko Kurasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ishiwata Isamu
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | | | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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12
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Isogai T, Kamiya CA. Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality. Int Heart J 2019; 60:503-511. [DOI: 10.1536/ihj.18-729] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshiaki Isogai
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center
| | - Chizuko A. Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
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13
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Katsuragi S, Tanaka H, Hasegawa J, Kanayama N, Nakata M, Murakoshi T, Osato K, Nakamura M, Tanaka K, Sekizawa A, Ishiwata I, Yamamoto Y, Wakasa T, Takeuchi M, Yoshimatsu J, Ikeda T. Analysis of preventability of malignancy-related maternal death from the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2019; 34:432-438. [PMID: 30999803 DOI: 10.1080/14767058.2019.1609930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: We reviewed malignancy related maternal deaths in Japan to ascertain if there were avoidable factors.Methods: Malignancy-related maternal death in Japan reported to the Maternal Death Exploratory Committee, from 2010 to 2016 inclusive.Results: There were 12 cases of maternal death caused by malignancy. There were four gastric cancers (two poorly differentiated adenocarcinoma, one signet ring cell carcinoma with adenocarcinoma, one histology not available), 3 leukemia (two acute myeloid leukemia, one aggressive NK cell leukemia), two ureteral cancers (histology not available), one malignant lymphoma (diffuse large B-cell lymphoma with translocation), one brain tumor (gliomatosis cerebri), and one cervical cancer (glassy cell carcinoma). Two gastric cancer patients had chronic gastric pain before conception. In two cases the physicians commented that they had avoided computed tomography and the brain biopsy needed for diagnosis because the patient was pregnant. At diagnosis, the clinical stages were II-IV in 9, and the performance status was 3-5 in 8. Indication for delivery was exacerbated maternal condition in 5, for treatment in 3, spontaneous labor in 3, and one patient declined elective delivery. Median [interquartile rage] (range) gestational weeks of delivery was 29 [24-30] (19-40). One cervical cancer patient had a radical hysterectomy and chemotherapy for 10 months. However, three leukemia and one gastric cancer patients had chemotherapy within 10 d because they deteriorated rapidly. Another seven cases did not have any treatment because of poor general condition or because they remained undiagnosed. In all cases, the Committee considered that there was no evidence of substandard care.Conclusion: In these cases, both the clinical stages and biological degree of malignancy were high. In two-thirds of cases, early termination of the pregnancy was indicated because of deteriorating maternal condition. Chemotherapy was not effective because of short available time for therapy and the advanced stage of the cancers when diagnosed. Encouraging women to have a thorough medical assessment before conception, and early diagnosis and treatment before pregnancy, appears to be the only practical way to reduce deaths from malignancy while a woman is pregnant.
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Affiliation(s)
- Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kanagawa, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Yoshiko Yamamoto
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoko Wakasa
- Department of Diagnostic Pathology, Kindai University Faculty of Medicine, Nara Hospital, Ikoma, Japan
| | - Makoto Takeuchi
- Department of Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Jun Yoshimatsu
- Department of Perinatology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Silvestri V, Mazzesi G, Mele R. Postpartum aortic dissection. A case report and review of literature. Int J Surg Case Rep 2019; 56:101-106. [PMID: 30870737 PMCID: PMC6425083 DOI: 10.1016/j.ijscr.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiovascular comorbidities may complicate pregnancy. Pregnancy carries a 25-fold relative risk for aortic dissection. Dissection may occur in pregnancies without known genetic or anatomical risk factors (non syndromic sporadic aortic dissection). Dissection may occur in the postpartum period. Given the high mortality for both mother and foetus, a high clinical suspicion for aortic dissection is needed in an emergency setting in postpartum.
Introduction Aortic dissection is a rare cardiovascular complication in pregnancy. Most of the cases occur during the third trimester of pregnancy, whilst 33% of cases are reported during the postpartum period. Presentation of case We report the case of a multiparous 35-year-old patient with gestational hypertension treated for a type A aortic dissection on the second postpartum day. A review of literature on non-syndromic sporadic aortic dissection during the postpartum period is presented. Discussion Aortic complications in pregnancy have been described in genetic syndromes or congenital aortic malformations but may also be non -syndromic and occur in the absence of any other risk factor. Pregnancy carries a 25-fold increase in relative risk for dissection. A review of the 16 cases published in literature from 1995 to December 2016 of non-syndromic, sporadic aortic dissections in pregnancy showed that the event may occur more frequently in the first week post-partum, be symptomatic for thoracic pain or dyspnoea. Type A aortic dissection accounts to 75% of cases. Mortality, despite surgical treatment, has been reported in 4 cases. Conclusions Even though rarely reported, given the increasing incidence and the high mortality of aortic dissection in pregnancy, along with the potential challenge for two lives, clinician must consider aortic dissection in post-partum while dealing with differential diagnosis in post-partum patients in the emergency setting.
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Affiliation(s)
- Valeria Silvestri
- Surgical Science Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy; Cardiac Surgery Unit, Cardiovascular, Respiratory, Nefrologic and Geriatric Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy.
| | - Giuseppe Mazzesi
- Surgical Science Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy; Cardiac Surgery Unit, Cardiovascular, Respiratory, Nefrologic and Geriatric Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Rita Mele
- Surgical Science Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy; Cardiac Surgery Unit, Cardiovascular, Respiratory, Nefrologic and Geriatric Department, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
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15
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Horiuchi C, Kamiya CA, Ohuchi H, Miyoshi T, Tsuritani M, Iwanaga N, Neki R, Niwa K, Kurosaki K, Ichikawa H, Ikeda T, Yoshimatsu J. Pregnancy outcomes and mid-term prognosis in women after arterial switch operation for dextro-transposition of the great arteries - Tertiary hospital experiences and review of literature. J Cardiol 2018; 73:247-254. [PMID: 30579805 DOI: 10.1016/j.jjcc.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/03/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) has gradually replaced the atrial switch operation and has become the standard operation. To date, the outcomes of pregnant women with d-TGA after this new operation have not been investigated. In this study, we investigated the impact of ASO on pregnant outcomes and mid-term prognosis in women with d-TGA and compared with the atrial switch operation through the literature review. METHODS AND RESULTS There were 20 pregnancies in 10 women with d-TGA after ASO and 6 resulted in abortion. Among 14 successful pregnancies in 10 women, 11 pregnancies achieved the term delivery and 3 pregnancies, including 1 twin pregnancy, resulted in preterm labor. Maternal cardiovascular events occurred in 4 (heart failure and arrhythmias in 3 and arrhythmia in 1), and all were controllable with medications. Risk factors for the peripartum cardiac events were older age at ASO and delivery, and higher concentration of brain natriuretic peptide (BNP) at first trimester (p<0.05). In 7-60 month-follow-up after delivery, no case showed deterioration of functional class and systemic ventricular function. According to the literature review, women after ASO demonstrated a better prognosis than those after the atrial switch operation. CONCLUSIONS The majority of women with d-TGA after ASO tolerated pregnancy and delivery well. The older age at ASO, an elderly pregnancy, and higher BNP levels at the first trimester were possibly risk factors of peripartum cardiovascular events among the group. The literature reviews and this study may indicate the advantage of systemic left ventricle compared with systemic right ventricle in long-term outcomes after delivery.
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Affiliation(s)
- Chinami Horiuchi
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Chizuko A Kamiya
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideo Ohuchi
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takekazu Miyoshi
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Mitsuhiro Tsuritani
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoko Iwanaga
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Reiko Neki
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koichiro Niwa
- Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - Kenichi Kurosaki
- Departments of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hajime Ichikawa
- Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Ikeda
- Departments of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Jun Yoshimatsu
- Departments of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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16
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Katsuragi S, Tanaka H, Hasegawa J, Nakamura M, Kanayama N, Nakata M, Murakoshi T, Yoshimatsu J, Osato K, Tanaka K, Sekizawa A, Ishiwata I, Ikeda T. Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2018; 32:3420-3426. [PMID: 29699420 DOI: 10.1080/14767058.2018.1465549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Hypertensive disorder of pregnancy (HDP) is a major cause of maternal death. The goal of this study was to investigate factors associated with maternal death due to HDP. Study design: HDP-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor and Welfare from 2010 to 2015 were examined. Results: Out of 47 cases of HDP, 30 were identified as the major cause of maternal death. The median maternal age was 34 years (range 24-45) and the mortality in women aged ≥40 years was seven times higher that than in women aged <34 years. The etiologies were intracerebral hemorrhage (n = 22), subarachnoid hemorrhage (n = 3), subcapsular hematoma of the liver (n = 2), peripartum cardiomyopathy (n = 2), and eclampsia (n = 1), and 19 cases were deemed preventable. The most frequent antepartum problems were delays in hospitalization, maternal transfer, and termination of pregnancy. In four cases, diagnosis of HELLP syndrome was too late because laboratory data were not checked, despite the patient reporting epigastric pain or showing elevation of blood pressure (BP). Treatment for lowering of BP was improper in 2/3 intrapartum cases, even though BP was elevated during pregnancy (144 versus 188 mmHg, p < .001). There was inadequate lowering of BP and lack of use of magnesium sulfate in 7/11 postpartum cases (64%), despite aspartate aminotransferase (AST) (p < .005), alanine aminotransferase (ALT) (p < .01), lactate dehydrogenase (LDH) (p < .005), and platelet count (PLT) (p < .01) all significantly worsening after delivery. Conclusion: HDP accounts for 11% of maternal deaths in Japan. Mothers aged ≥40 years are most at risk for HDP-related maternal death. Major concerns for preventabilities were late hospitalization, maternal transportation, and termination of pregnancy for term or near-term HDP. Regular vital checks and prompt lowering of BP were lacked during labor in most cases. HELLP syndrome should be managed at a general hospital with sufficient medical resources.
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Affiliation(s)
- Shinji Katsuragi
- a Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan
| | - Hiroaki Tanaka
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Junichi Hasegawa
- c Department of Obstetrics and Gynecology , St Marianna University School of Medicine , Kanagawa , Japan
| | - Masamitsu Nakamura
- d Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Naohiro Kanayama
- e Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Masahiko Nakata
- f Department of Obstetrics and Gynecology , Toho University , Tokyo , Japan
| | - Takeshi Murakoshi
- g Division of Perinatology, Maternal and Perinatal Care Center , Seirei Hamamatsu General Hospital , Hamamatsu , Japan
| | - Jun Yoshimatsu
- h Department of Perinatology and Gynecology , National Cerebral Cardiovascular Center , Osaka , Japan
| | - Kazuhiro Osato
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Kayo Tanaka
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Akihiko Sekizawa
- d Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Isamu Ishiwata
- i Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan
| | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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17
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Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan. Heart Vessels 2018; 33:918-930. [DOI: 10.1007/s00380-018-1137-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/09/2018] [Indexed: 10/18/2022]
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18
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Krexi D, Sheppard MN. Cardiovascular causes of maternal sudden death. Sudden arrhythmic death syndrome is leading cause in UK. Eur J Obstet Gynecol Reprod Biol 2017; 217:177. [PMID: 28843875 DOI: 10.1016/j.ejogrb.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Dimitra Krexi
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, Jenner Wing, Floor 1, Cranmer Terrace, St George's University of London, London SW17 0RE, UK
| | - Mary N Sheppard
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, Jenner Wing, Floor 1, Cranmer Terrace, St George's University of London, London SW17 0RE, UK.
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19
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Krexi D, Sheppard MN. Cardiovascular causes of maternal sudden death. Sudden Arrhythmic Death Syndrome is leading cause in UK. Eur J Obstet Gynecol Reprod Biol 2017; 216:261. [PMID: 28802710 DOI: 10.1016/j.ejogrb.2017.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to determine the causes of sudden cardiac death during pregnancy and in the postpartum period and patients' characteristics. There are few studies in the literature. METHODS Eighty cases of sudden unexpected death due to cardiac causes in relation to pregnancy and postpartum period in a database of 4678 patients were found and examined macroscopically and microscopically. RESULTS The mean age was 30±7years with a range from 16 to 43 years. About 30% were 35 years old or older; 50% of deaths occurred during pregnancy and 50% during the postpartum period. About 59.18% were obese or overweight where body mass index data were available. The leading causes of death were sudden arrhythmic death syndrome (SADS) (53.75%) and cardiomyopathies (13.80%). Other causes include dissection of aorta or its branches (8.75%), congenital heart disease (2.50%) and valvular disease (3.75%). CONCLUSION This study highlights sudden cardiac death in pregnancy or in the postpartum period, which is mainly due to SADS with underlying channelopathies and cardiomyopathy. We wish to raise awareness of these frequently under-recognised entities in maternal deaths and the need of cardiological screening of the family as a result of the diagnosis.
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Affiliation(s)
- Dimitra Krexi
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George's University of London, London, United Kingdom
| | - Mary N Sheppard
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George's University of London, London, United Kingdom.
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Katsuragi S, Tanaka H, Hasegawa J, Nakamura M, Kanayama N, Nakata M, Murakoshi T, Yoshimatsu J, Osato K, Tanaka K, Sekizawa A, Ishiwata I, Ikeda T. Analysis of preventability of stroke-related maternal death from the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2017; 31:2097-2104. [PMID: 28610468 DOI: 10.1080/14767058.2017.1336222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The number of stroke-related maternal deaths is increasing in Japan. We investigated methods to reduce maternal death from stroke. METHODS We analyzed stroke-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor, and Welfare from 2010 to 2014 inclusive. RESULTS A total of 35 cases were identified. The median maternal age was 35 years (range 22-45) and the incidence of stoke in women ≥40 was seven-fold higher than in <34. Etiologies were pregnancy induced hypertension in 16, subarachnoid hemorrhage in seven, cerebral infarction in three, arteriovenous malformation in two, Moyamoya disease in one, and origin unknown cerebral hemorrhage in six. These cases occurred in antepartum 43%, in postpartum 31%, and in intrapartum 26%. 23 cases were deemed non-preventable and 12 cases preventable. Possible preventable factors occurred antepartum in 23, postpartum in seven, and intrapartum in six. Preventable features included inadequate hypertension control (33%), presenting too late for termination of pregnancy (14%), delayed hospitalization (11%), and delayed maternal transfer (11%). CONCLUSIONS A total of 90% of strokes were hemorrhagic, and older mothers (≥ 40) were most at risk. Most possible preventable factors occurred antepartum, and improved control of hypertension and earlier termination would help to reduce maternal death from stroke.
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Affiliation(s)
- Shinji Katsuragi
- a Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan
| | - Hiroaki Tanaka
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Junichi Hasegawa
- c Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kanagawa , Japan
| | - Masamitsu Nakamura
- d Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Naohiro Kanayama
- e Department of Obstetrics and Gynaecology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Masahiko Nakata
- f Department of Obstetrics and Gynecology , Toho University , Tokyo , Japan
| | - Takeshi Murakoshi
- g Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan
| | - Jun Yoshimatsu
- h Department of Perinatology and Gynecology , National Cerebral Cardiovascular Center , Osaka , Japan
| | - Kazuhiro Osato
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Kayo Tanaka
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Akihiko Sekizawa
- d Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Isamu Ishiwata
- i Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan
| | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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21
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In-hospital management and outcomes in patients with peripartum cardiomyopathy: a descriptive study using a national inpatient database in Japan. Heart Vessels 2017; 32:944-951. [PMID: 28233090 DOI: 10.1007/s00380-017-0958-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening cardiac disorder characterized by maternal systolic heart failure. Although PPCM is a major cause of maternal mortality, little is known about the acute-phase management of PPCM in real-world clinical settings. We retrospectively identified patients hospitalized with PPCM from 2007 to 2014 using the Diagnosis Procedure Combination database in Japan. We investigated patient characteristics, in-hospital examinations and treatment, and in-hospital outcomes. The study patients were 283 patients hospitalized with PPCM at 177 hospitals. The mean age was 32.7 ± 5.5 years. Of the eligible patients, 134 (47.3%) patients had a hypertensive disorder, including 48 (17.0%) patients with pre-eclampsia, and 111 (39.2%) patients were admitted to the intensive care unit or emergency center. Coronary angiography, cardiac magnetic resonance imaging, and endomyocardial biopsy were performed during hospitalization in 69 (24.4%), 42 (14.8%), and 43 (15.2%) patients, respectively. Invasive pulmonary artery pressure monitoring was used in 14 (4.9%) patients. Mechanical circulatory support was used in 13 (4.6%) patients (intra-aortic balloon pumping, n = 12; extracorporeal membrane oxygenation, n = 5; ventricular assist device, n = 0). Catecholamine therapy and phosphodiesterase-III inhibitor therapy were used in 79 (27.9%) and 13 (4.6%) patients, respectively. Prolactin blockade therapy was used in 78 (27.6%) patients. During hospitalization, four (1.4%) patients died and nine (3.2%) patients developed ventricular tachycardia or fibrillation. Two (0.7%) patients received an implantable cardioverter defibrillator, but no patient received other permanent cardiac devices. This retrospective cohort study suggests that attending physicians should be ready to provide intensive care for patients with PPCM during the acute phase.
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Hasegawa J, Wakasa T, Matsumoto H, Takeuchi M, Kanayama N, Tanaka H, Katsuragi S, Nakata M, Murakoshi T, Osato K, Nakamura M, Sekizawa A, Ishiwata I, Ikeda T. Analysis of maternal death autopsies from the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med 2017; 31:333-338. [PMID: 28110592 DOI: 10.1080/14767058.2017.1285890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan. METHODS Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed. RESULTS Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy. CONCLUSION Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.
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Affiliation(s)
- Junichi Hasegawa
- a Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kanagawa , Japan
| | - Tomoko Wakasa
- b Department of Diagnostic Pathology , Nara Hospital, Kindai University Faculty of Medicine , Ikoma , Japan
| | - Hiroshi Matsumoto
- c Department of Legal Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Makoto Takeuchi
- d Department of Pathology , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan
| | - Naohiro Kanayama
- e Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Hiroaki Tanaka
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Shinji Katsuragi
- g Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan
| | - Masahiko Nakata
- h Department of Obstetrics and Gynecology , Toho University School of Medicine , Tokyo , Japan
| | - Takeshi Murakoshi
- i Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan
| | - Kazuhiro Osato
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Masamitsu Nakamura
- j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Akihiko Sekizawa
- j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Isamu Ishiwata
- k Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan
| | - Tomoaki Ikeda
- f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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