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Ezveci H, Doğru Ş, Akkuş F, Metin ÜS, Gezginc K. Maternal Cardiac Disease and Perinatal Outcomes in a Single Tertiary Care Center. Z Geburtshilfe Neonatol 2024. [PMID: 38830384 DOI: 10.1055/a-2311-4945] [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: 06/05/2024]
Abstract
OBJECTIVE This study aims to compare the perinatal outcomes of pregnant women with heart disease and a healthy pregnant control group, as well as the maternal and newborn outcomes of pregnant women with congenital heart disease and acquired heart disease. MATERIAL METHOD Pregnant women with heart disease and healthy control pregnant women were included in this retrospective study. Sociodemographic data of all patients included in the study were obtained from electronic records. Perinatal outcomes of all patients were compared. RESULTS A total of 258 pregnant women were included in the study. While 129 pregnant women were diagnosed with heart disease, 129 patients were low-risk pregnant women. Preeclampsia (p=0.004) and cesarean section (p=0.01) rates were higher in pregnant women with heart disease compared to healthy pregnant women. Compared with healthy pregnant women, pregnant women with heart disease had a lower birth weight (p=0.003), a higher fetal growth restriction (FGR) rate (p=0.036), lower birth percentiles (p=0.002), a lower 5-minute APGAR (p=0.0001), a higher neonatal intensive care unit (NICU) admission rate (p=0.001), and a longer NICU stay rate (p=0.001). The mean gestational age at birth of pregnant women with congenital heart disease was higher than that of those with acquired heart disease (p=0.017). CONCLUSION It was observed that all maternal heart diseases were associated with adverse perinatal outcomes compared to healthy pregnant women. In this series, perinatal adverse outcomes of pregnant women with congenital and acquired heart disease did not differ.
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Affiliation(s)
- Huriye Ezveci
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Şükran Doğru
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Fatih Akkuş
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
| | - Ülfet Sena Metin
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology, Konya, Turkey
| | - Kazim Gezginc
- Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
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Liu JL, Wang Q, Qu DY. Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment. World J Psychiatry 2024; 14:63-75. [PMID: 38327887 PMCID: PMC10845230 DOI: 10.5498/wjp.v14.i1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Postpartum quality of life (QoL) in women with heart disease has been neglected. AIM To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns. METHODS The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression. RESULTS This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525). CONCLUSION Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.
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Affiliation(s)
- Jia-Lin Liu
- Department of Obstetrics and Gynecology, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Qi Wang
- Department of Psychiatry, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Dong-Ying Qu
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
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Thakkar A, Hameed AB, Makshood M, Gudenkauf B, Creanga AA, Malhamé I, Grandi SM, Thorne SA, D'Souza R, Sharma G. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity. JACC. ADVANCES 2023; 2:100275. [PMID: 37560021 PMCID: PMC10410605 DOI: 10.1016/j.jacadv.2023.100275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 08/11/2023]
Abstract
Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes.
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Affiliation(s)
- Aarti Thakkar
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afshan B. Hameed
- Department of Obstetrics & Gynecology, Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - Minhal Makshood
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent Gudenkauf
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia M. Grandi
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Departments of Obstetrics & Gynaecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Chang SA, Khakh P, Janzen M, Kiess M, Rychel V, Grewal J. Pregnancy related changes in Doppler gradients and left ventricular mechanics in women with sub-valvular or valvular aortic stenosis. Echocardiography 2021; 38:1754-1761. [PMID: 34672021 DOI: 10.1111/echo.15208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of our study was to characterize echocardiographic changes during pregnancy in women with known LVOT obstruction or AS compared to the healthy pregnancy controls, and to assess the relationship with pregnancy outcomes. METHODS We retrospectively studied 34 pregnant patients with congenital LVOT obstruction or AS with healthy age-matched pregnant controls. Patients with other significant valvular lesions, structural heart disease (LVEF < 40%), or prior valve surgery were excluded. All LVOTO/AS patients underwent a minimum of two consecutive echocardiograms between 1 year pre-conception and 1 year postpartum, with at least two studies during the pregnancy. Comprehensive echocardiographic evaluation was performed including speckle-tracking LV global longitudinal strain. RESULTS A total of 83 echocardiograms from the study group and 34 echocardiograms from the control group were evaluated. Over the range of LVOTO/AS, a significantly greater increase in the AV gradients and LV and LA volumes were observed as compared with the controls. In the sub-group of LVOTO/AS pregnant women with ≥ moderate (n = 8) versus < moderate LVOTO/AS (n = 26), averaged 2nd /3rd trimester LVEF was lower (51 ± 12)% versus (58 ± 4)%, (p = 0.02) and GLS was lower (-19.5 ± 2.8) versus (21.2 ± 2.4), (p = 0.06). Pregnancy was well tolerated despite these changes. CONCLUSION Among pregnant women with even milder forms of LVOTO/AS, increases in cardiac volumes and AV gradients can be expected over the course of pregnancy. Significant decreases in LV function and mechanics were only observed in women with moderate or greater LVOTO/AS, although still remained in normal range.
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Affiliation(s)
- Soohyun A Chang
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parm Khakh
- University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Mikyla Janzen
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marla Kiess
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Valerie Rychel
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jasmine Grewal
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Slaibi A, Ibraheem B, Mohanna F. Challenging management of a pregnancy complicated by Eisenmenger syndrome; A case report. Ann Med Surg (Lond) 2021; 69:102721. [PMID: 34457254 PMCID: PMC8379476 DOI: 10.1016/j.amsu.2021.102721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Women with Eisenmenger syndrome are usually advised to avoid pregnancy because of the high maternal mortality rate of 30-50% which increases up to 65% in the case of a cesarean section. Successful management of Eisenmenger syndrome in pregnancy is tricky and has a narrow margin of safety; however, carefully coordinated multidisciplinary care can profoundly optimize the chances of survival for both mother and baby. CASE PRESENTATION A 28-year-old, 24-week-pregnant patient with a non-corrective ventricular septal defect (VSD) was diagnosed with Eisenmenger syndrome but elected to continue her pregnancy despite the high risks on her and her fetus. Therefore, a multidisciplinary team was assembled to fully monitor the patient and ensure that she reaches 32 weeks before delivery. CLINICAL DISCUSSION Multiple scenarios for timing and mode of delivery were discussed. Following the recommendation of the 2018 European Society of Cardiology guidelines and because of the fetus' transverse position, a cesarean section was performed at week 32 and both the patient and her child were saved. CONCLUSION Termination of pregnancy is the safer option only if it were done early on in the pregnancy. Thus, when the pregnancy is continued, an expert multidisciplinary team is put together to support the patient.
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Affiliation(s)
- Anas Slaibi
- Department of Pathology, Cancer Research Center at Tishreen University Hospital, Latakia, Syria
| | - Bassel Ibraheem
- Department of Cardiology at Al-Bassel Hospital, Tartus, Syria
| | - Farah Mohanna
- Department of Pathology, Cancer Research Center at Tishreen University Hospital, Latakia, Syria
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Precision dosing of methadone during pregnancy: A pharmacokinetics virtual clinical trials study. J Subst Abuse Treat 2021; 130:108521. [PMID: 34118695 DOI: 10.1016/j.jsat.2021.108521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/05/2021] [Accepted: 05/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Methadone use for the management of opioid dependency during pregnancy is commonplace. Methadone levels are altered during pregnancy due to changes in maternal physiology. Despite this, a paucity of data exist regarding the most appropriate optimal dosing regimens during pregnancy. METHODS This study applied a pharmacokinetic modeling approach to examine gestational changes in R- and S-methadone concentrations in maternal plasma and fetal (cord) blood. This study did so to derive a theoretical optimal dosing regimen during pregnancy, and to identify the impact of Cytochromes P450 (CYP) 2B6 and 2C19 polymorphisms on methadone maternal and fetal pharmacokinetics. RESULTS The study noted significant decreases in maternal R- and S-methadone plasma concentrations during gestation, with concomitant increases in fetal levels. At a dose of 90 mg once daily, 75% (R-) and 94% (S-) of maternal methadone trough levels were below the lower therapeutic window at term (week 40). The developed optimal dosing regimen escalated doses to 110 mg by week 5, followed by 10 mg increments every 5 weeks up to a maximum of 180 mg once daily near term. This increase resulted in 27% (R-) and 11% (S-) of subjects with trough levels below the lower therapeutic window at term. CYP2B6 poor metabolizers (PM) and either CYP2C19 extensive metabolizers (EM), PM, or ultra-rapid (UM) metabolizer phenotypes demonstrated statistically significant increases in concentrations when compared to their matched CYP2B6 EM counterparts. CONCLUSIONS Specific and gestation-dependent dose titrations are required during pregnancy to reduce the risks associated with illicit drug use and to maintain fetal safety.
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Afari HA, Davis EF, Sarma AA. Echocardiography for the Pregnant Heart. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:55. [PMID: 34075291 PMCID: PMC8160078 DOI: 10.1007/s11936-021-00930-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
Purpose of review Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. Recent findings In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. Summary Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.
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Affiliation(s)
| | - Esther F. Davis
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
| | - Amy A. Sarma
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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O'Kelly AC, Sharma G, Vaught AJ, Zakaria S. The Use of Echocardiography and Advanced Cardiac Ultrasonography During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:71. [PMID: 31754837 PMCID: PMC8015779 DOI: 10.1007/s11936-019-0785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Pregnancy is a time of significant cardiovascular change. Echocardiography is the primary imaging modality used to assess cardiovascular anatomy and physiology during pregnancy. Both two-dimensional (2D) echocardiography and advanced cardiac ultrasound modalities play pivotal roles in identifying and monitoring these changes, especially in women with preexisting or new cardiac disease. This paper reviews the role of echocardiography and advanced cardiac ultrasound during normal pregnancy and pregnancy complicated by hypertensive disorders, valvular disorders, and cardiomyopathy. It also examines the role of echocardiography in guiding decisions about delivery. RECENT FINDINGS The data establishing normal echo parameters during pregnancy are inconsistent. In addition, there is limited research exploring the role of advanced cardiac ultrasound modalities, such as tissue Doppler imaging or speckle tracking echocardiography, in assessing cardiac function during pregnancy. What data there are suggest that these advanced modalities can be used to identify subclinical changes before traditional echocardiography can, and thus have clear utility in identifying early abnormal cardiac responses to pregnancy. Echocardiography is the modality of choice for imaging the heart in pregnant women. Advanced ultrasound modalities increasingly play a role in identifying abnormal adaptations to pregnancy and detecting subclinical changes. This, in turn, can help promote a healthy pregnancy for both mother and fetus.
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Affiliation(s)
- Anna C O'Kelly
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
| | - Arthur Jason Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 660 North Wolfe Street, Phipps 228, Baltimore, MD, 21287, USA
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave. Bldg 301, Suite 2400, Baltimore, MD, 21224, USA
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Bassaw B, Singh D, Chinnia J, Karan A, Ramsarran J. Uni-ventricular pregnancy: a case report in a low resource country. J OBSTET GYNAECOL 2019; 40:128-129. [PMID: 31607195 DOI: 10.1080/01443615.2019.1581751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Bharat Bassaw
- Faculty of Medical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Dinesh Singh
- Mt. Hope Maternity Hospital, Champs Fleurs, Trinidad and Tobago
| | - Javed Chinnia
- Mt. Hope Maternity Hospital, Champs Fleurs, Trinidad and Tobago
| | - Abhinav Karan
- Mt. Hope Maternity Hospital, Champs Fleurs, Trinidad and Tobago
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Bottega N, Malhamé I, Guo L, Ionescu‐Ittu R, Therrien J, Marelli A. Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease. CONGENIT HEART DIS 2019; 14:735-744. [DOI: 10.1111/chd.12811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Natalie Bottega
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal Quebec Canada
| | - Isabelle Malhamé
- Department of Medicine Women and Infants Hospital Providence Rhode Island
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal Quebec Canada
| | - Raluca Ionescu‐Ittu
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal Quebec Canada
| | - Judith Therrien
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal Quebec Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal Quebec Canada
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Kinsella CM, Thorne SA, Chong H, Clift PF, Vasallo Peraza R, Perez Torga JE, Roman Rubio PA. Delivery outcomes in women with congenital heart disease: results from the Cuban National Programme for pregnancy and heart disease. JOURNAL OF CONGENITAL CARDIOLOGY 2019. [DOI: 10.1186/s40949-019-0025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Maskell P, Burgess M, MacCarthy‐Ofosu B, Harky A. Management of aortic valve disease during pregnancy: A review. J Card Surg 2019; 34:239-249. [DOI: 10.1111/jocs.14039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Perry Maskell
- Department of Vascular SurgeryCountess of Chester HospitalChester England
| | - Mika Burgess
- Department of Obstetrics and GynaecologyYsbyty GwyneddBangor Wales
| | | | - Amer Harky
- Department of Vascular SurgeryCountess of Chester HospitalChester England
- School of MedicineUniversity of LiverpoolLiverpool England
- Department of Cardiothoracic SurgeryLiverpool Heart and ChestLiverpool UK
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Aydin E, Ozyuncu O, Kasapoglu D, Orgul G, Ozer N, Yurdakok M, Beksac MS. Clinical analyses of 383 cases with maternal cardiac diseases. J Perinat Med 2018. [PMID: 28622145 DOI: 10.1515/jpm-2017-0023] [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] [Indexed: 01/12/2023]
Abstract
AIM To evaluate the pregnancy outcomes of women with heart disease. MATERIALS AND METHODS In this retrospective study, 383 pregnant women with cardiac diseases were examined. The cases were classified according to the World Health Organization (WHO) classification. The distribution of the cases according to class, congenital heart diseases, mean birthweight, mean gestational week at delivery, type of delivery [cesarean section (CS) or vaginal delivery], and cardivascular events (during pregnancy and puerperium) were evaluated. RESULTS Of the 383 patients, 25 were in Class I; 39, Class II; 255, Class II or III; 31, Class III; and 33, Class IV cardiac diseases. The neonatal birth weights were significantly lower in Class III than in Classes II, and II or III. The preterm delivery rate was higher in Class III than in the other classes. Delivery was performed by CS due to cardiac indications in the high-risk classes, however, only obstetric indications were considered in the low-risk classes. Only one case of maternal death occurred during the postpartum period, in a patient with Eisenmenger's syndrome. DISCUSSION Cardiovascular diseases are an important cause of mortality and morbidity in pregnancy. The adverse impact of cardiovascular disorders on pregnancy outcomes should be the main concern during the management of these women.
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Affiliation(s)
- Emine Aydin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 06100, Sıhhiye, Ankara, Turkey, Phone: +90 312 305 2477, Fax: +90 312 305 2315
| | - Ozgur Ozyuncu
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | | | - Gokcen Orgul
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
| | - Necla Ozer
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Murat Yurdakok
- Hacettepe University Faculty of Medicine, Department of Child Health and Diseases, Neonatology Unit, Ankara, Turkey
| | - M Sinan Beksac
- Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
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Non-obstetrical indications for cesarean section: a state-of-the-art review. Arch Gynecol Obstet 2018; 298:9-16. [DOI: 10.1007/s00404-018-4742-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/04/2018] [Indexed: 01/31/2023]
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Haemodynamic changes during labour: continuous minimally invasive monitoring in 20 healthy parturients. Int J Obstet Anesth 2017; 31:74-83. [DOI: 10.1016/j.ijoa.2017.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/19/2017] [Accepted: 03/02/2017] [Indexed: 01/12/2023]
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Fang G, Li M, Li J, Lin L, Mei W. Anesthetic management of cesarean delivery in parturients with ruptured sinus of Valsalva aneurysm: CARE-compliant 2 case reports and literature review. Medicine (Baltimore) 2017; 96:e6833. [PMID: 28489765 PMCID: PMC5428599 DOI: 10.1097/md.0000000000006833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Ruptured sinus of Valsalva aneurysm is rare and dangerous in parturients. Few cases of ruptured SVA in pregnancy are reported, and the anesthetic management for cesarean delivery has scarcely been described. PATIENT CONCERNS A parturient at 37-week gestation complained of a sore throat and cough that started 3 days before admission, followed 1 day later by fever, dizziness, breathlessness, and palpitation on exertion. Case two at 36-week gestation complained of a 1-day history of bloating in the lower abdomen. DIAGNOSES Full term and preterm parturients with ruptured sinus of Valsalva aneurysm. INTERVENTIONS Cesarean deliveries were performed with incremental epidural anesthesia technique under invasive monitoring. Surgical correction of the ruptured sinus of Valsalva aneurysms and ventricular septal defect were performed uneventfully 13 days and 7 days postpartum, respectively, for the 2 cases. OUTCOMES No complications were observed in the intra- or postoperative period for both mothers and babies. LESSONS We reviewed the pertinent literature and reached the following conclusions: use of a multidisciplinary team to guide anesthetic management is helpful and necessary; and both general anesthesia and incremental epidural anesthesia can be safely used in parturients with ruptured sinus of Valsalva aneurysm.
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Affiliation(s)
| | - Man Li
- Department of Anesthesiology
| | - Jian Li
- Department of Anesthesiology
- Department of Anesthesiology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Li Lin
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Wei Mei
- Department of Anesthesiology
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Bouma BJ, Mulder BJ. Changing Landscape of Congenital Heart Disease. Circ Res 2017; 120:908-922. [DOI: 10.1161/circresaha.116.309302] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 01/23/2023]
Abstract
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged. However, a large range of complications raised at the horizon as arrhythmias, endocarditis, pulmonary hypertension, and heart failure, and the need for additional treatment became clear. Technical solutions were sought in perfection and creation of new surgical techniques by developing catheter-based interventions, with elimination of open heart surgery and new electronic devices enabling, for example, multisite pacing and implantation of internal cardiac defibrillators to prevent sudden death. Over time, many pharmaceutical studies were conducted, changing clinical treatment slowly toward evidence-based care, although results were often limited by low numbers and clinical heterogeneity. More attention has been given to secondary issues like sports participation, pregnancy, work, and social-related difficulties. The relevance of these issues was already recognized in the 1970s when the need for specialized centers with multidisciplinary teams was proclaimed. Finally, research has become incorporated in care. Results of intervention studies and registries increased the knowledge on epidemiology of adults with congenital heart disease and their complications during life, and at the end, several guidelines became easily accessible, guiding physicians to deliver care appropriately. Over the past decades, the landscape of adult congenital heart disease has changed dramatically, which has to be continued in the future.
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Affiliation(s)
- Berto J. Bouma
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J.M. Mulder
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Partana P, Tan JKH, Tan JL, Tan LK. Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot. BMJ Case Rep 2017; 2017:bcr-2016-216809. [PMID: 28100569 DOI: 10.1136/bcr-2016-216809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pentalogy of Fallot is a cyanotic congenital heart disease that has guarded prognosis without surgical intervention in infancy. Women with uncorrected defects rarely survive into childbearing age and pregnancy in this group is associated with a high rate of perinatal loss. Physiological cardiovascular changes in pregnancy can lead to maternal haemodynamic instability with subsequent adverse cardiac sequelae with or without fetal decompensation. Optimum management and pregnancy outcomes in mother with uncorrected Pentalogy of Fallot and twin pregnancy have not been described in the literature. We describe a successful case of monochorionic diamniotic twin pregnancy in an affected woman who has not undergone surgical repair. Her pregnancy progressed without any adverse cardiopulmonary complications. Her caesarean delivery and postpartum recovery were favourable, with successful birth of two healthy babies at 35.7 weeks. This case emphasises the importance of a multidisciplinary team, especially of obstetricians with expertise in high-risk pregnancies, adult congenital heart disease cardiologists and anaesthesiologist.
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Affiliation(s)
- Pamela Partana
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Jarrod Kah Hwee Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Ju Le Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Lay Kok Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
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Tailor TD, Kicska GA, Jacobs JE, Pampaloni MH, Litmanovich DE, Reddy GP. Imaging of Heart Disease in Women. Radiology 2017; 282:34-53. [DOI: 10.1148/radiol.2016151643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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Santacesaria S, Cataldo S, Annoni GA, Corbella P, Fiocchi S, Vignati GM. Pregnancy in women with cardiovascular disease in the guidelines era: an Italian single-center experience. J Cardiovasc Med (Hagerstown) 2016; 17:750-5. [PMID: 26765992 DOI: 10.2459/jcm.0000000000000352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the present study is to determine pregnancy outcome with regard to the risk class and the modality way of referral to our joint Cardiac Obstetric Clinic. METHODS This is a prospective observational study. Patients referred to our clinic between 2011 and 2014 were included. Reason and timing for referral were recorded. Two groups were identified: women who were known to have cardiac disease before referral (group I) and women who were not (group II). Pregnancies were managed as recommended by the ESC Guidelines. Cardiac events were defined as death, heart failure requiring treatment, documented tachyarrhythmias, thromboembolic events and need for urgent endovascular procedures or surgery. RESULTS Of the 110 pregnancies, 51 (47%) were in group I and 57 (53%) in group II. Congenital (44%) and valvular (27%) diseases were the most frequent diagnosis. Thirty-two percent of patients were in WHO risk classes III-IV. Thirty percent were referred for symptoms, 70% for risk assessment. Women in group II were evaluated later in pregnancy than those in group I (25.6 ± 9 vs. 21.4 ± 9; P < 0.01). Cardiovascular events occurred in 15 (13.6%) pregnancies and were more common in WHO risk classes III-IV (11, P < 0.001), in group II (12, P= 0.02) and in patients referred for symptoms (11, P < 0.001). Stillbirths occurred only in classes III-IV (three pregnant, 2.7%). CONCLUSION There was no maternal or neonatal mortality and an overall acceptable incidence of cardiovascular events but a relevant percentage of pregnant were first referred late and/or for the onset of symptoms. Events were more frequent in these patients. Further efforts are needed to optimize referral to specialized centers.
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Affiliation(s)
- Sara Santacesaria
- aPediatric and Congenital Heart Disease Unit bObstetric Department cNeonatal Intensive Care Unit, Niguarda Hospital, Milan, Italy
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McLaughlin K, Drewlo S, Parker JD, Kingdom JC. Current Theories on the Prevention of Severe Preeclampsia With Low-Molecular Weight Heparin. Hypertension 2015; 66:1098-103. [DOI: 10.1161/hypertensionaha.115.05770] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/02/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Kelsey McLaughlin
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - Sascha Drewlo
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - John D. Parker
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - John C.P. Kingdom
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
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Abstract
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient. Endotracheal intubation in pregnancy carries an increased risk, due to airway edema and rapid oxygen desaturation following apnea. Few data are available to direct prolonged mechanical ventilation in pregnancy. Chest wall compliance is reduced, perhaps permitting slightly higher airway pressures. Optimizing oxygenation is important, but data on the use of permissive hypercapnia are limited. Delivery of the fetus does not always improve maternal respiratory function, but should be considered if benefit to the fetus is anticipated.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
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24
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Traiter les troubles du rythme supraventriculaires lors d’une grossesse. Presse Med 2015; 44:791-7. [DOI: 10.1016/j.lpm.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/03/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022] Open
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Elsherif Z, Mahmood N, Jamil S, Wagas H. Complex congenital heart disease in a complicated and precious pregnancy. BMJ Case Rep 2015; 2015:bcr-2015-209388. [PMID: 26135488 DOI: 10.1136/bcr-2015-209388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. A woman was assessed in our obstetric clinic for the first time at the gestational age of 28 weeks and found to have placental bleeding. She also had complex congenital heart disease and atrial fibrillation requiring anticoagulation. Echocardiography revealed double-inlet single ventricle with right and left atrioventricular valves entering into this chamber and levo-transposition of the great arteries. After an extensive discussion with the patient regarding the risks and benefits of anticoagulation including risk of stroke, the agreed plan was to start her on intravenous heparin with close observation and to continue pregnancy for at least 32 weeks in order to reduce the postpartum risk for the fetus. The pregnancy progressed without any further complications and the patient had elective caesarean section at 33 weeks of gestation and delivered a healthy baby boy.
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Affiliation(s)
- Zeinelabdien Elsherif
- King Abdul Aziz Medical City for National Guard, Riyadh, Central Region, Saudi Arabia
| | - Naveed Mahmood
- Department of Cardiology, King Abdul Aziz Medical City for National Guard, Riyadh, Central Region, Saudi Arabia
| | - Shazia Jamil
- Department of Obstetrics and Gynecology, King Abdul Aziz Medical City for National Guard, Riyadh, Central Region, Saudi Arabia
| | - Hadeel Wagas
- Department of Obstetrics and Gynecology, King Abdul Aziz Medical City for National Guard, Riyadh, Central Region, Saudi Arabia
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26
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Moriarty JM, Bolster F, O'Connor C, Fitzpatrick P, Lawler LP, Kavanagh EC, MacMahon PJ, Murray JG. Frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography. Can Assoc Radiol J 2015; 66:24-9. [PMID: 25623008 DOI: 10.1016/j.carj.2014.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/07/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA). MATERIALS AND METHODS CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action. RESULTS Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities. CONCLUSION Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.
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Affiliation(s)
- John M Moriarty
- David Geffen School of Medicine at UCLA, Diagnostic Cardiovascular Imaging, Los Angeles, California, USA
| | - Ferdia Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Clare O'Connor
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Patricia Fitzpatrick
- School of Public Health and Population Science, University College Dublin, Dublin, Ireland
| | - Leo P Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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Wang K, Luo H, Xin Y, Yu H. Successful pregnancy and delivery in patients with uncorrected single ventricle: Three new cases and literature review. Int J Cardiol 2015; 184:135-139. [PMID: 25703421 DOI: 10.1016/j.ijcard.2015.01.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 11/14/2014] [Accepted: 01/25/2015] [Indexed: 10/24/2022]
Abstract
Due to high risks of both maternal and fetal complications, pregnancy is not encouraged for women with uncorrected univentricular heart (UVH). Here, we report three cases of successful pregnancy and delivery in patients with uncorrected UVH. A literature review has been performed. It appears that maternal and neonatal risks are mainly associated with higher NYHA heart failure class, pulmonary hypertension, and history of congestive heart failure. In the absence of these risk factors, successful pregnancy still can be achieved with mild complications. Care by a multidisciplinary team during delivery is necessary to for a good prognosis.
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Affiliation(s)
- Kana Wang
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hong Luo
- Department of Diagnostic Ultrasound, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yalan Xin
- Department of Gynecology and Obstetrics, Meishan City Women and Child Care Hospital, Meishan, Sichuan 620010, China
| | - Haiyan Yu
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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29
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Bick D, Beake S, Chappell L, Ismail KM, McCance DR, Green JSA, Taylor C. Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: a systematic review. BMC Pregnancy Childbirth 2014; 14:428. [PMID: 25528045 PMCID: PMC4296678 DOI: 10.1186/s12884-014-0428-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/12/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND More women with an increased risk of poor pregnancy outcome due to pre-existing medical conditions are becoming pregnant. Although clinical care provided through multi-disciplinary team (MDT) working is recommended, little is known about the structure or working practices of different MDT models, their impact on maternal and infant outcomes or healthcare resources. The objectives of this review were to consider relevant international evidence to determine the most appropriate MDT models of care to manage complex medical conditions during and after pregnancy, with a specific focus on pre-existing diabetes or cardiac disease in high income country settings. METHODS Quantitative and qualitative evidence of MDT models of care for the management of pregnant/postnatal women with pre-existing diabetes and cardiac disease was considered. A search of the literature published between January 2002 - January 2014 was undertaken. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Given limited primary and secondary research evidence, guidelines and opinion papers were included. Two independent reviewers conducted critical appraisal of included papers. RESULTS Nineteen papers were included from UK, Canada, USA, the Netherlands and Singapore. No studies were found which had compared MDT models for pregnant/postnatal women with pre-existing diabetes or cardiac disease. Two small retrospective studies reported better outcomes for women with cardiac disease if an MDT approach was used, although evidence to support this was limited. Due to study heterogeneity it was not possible to meta-analyse data. No evidence was identified of MDT management in the postnatal period or impacts of MDT working on healthcare resources. CONCLUSIONS Despite widespread promotion of MDT models of care for pregnant and postnatal women with pre-existing diabetes or cardiac disease, there is a dearth of primary evidence to inform structure or working practices or beneficial impact on maternal and infant outcomes or healthcare resources. Primary research into if or how MDT models of care improve outcomes for women with complex pregnancies is urgently needed.
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Affiliation(s)
- Debra Bick
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Sarah Beake
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Lucy Chappell
- Women's Health Academic Centre, Guys and St Thomas' NHS Foundation Trust, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Khaled M Ismail
- Birmingham Centre for Women's and Children's Health, School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - James S A Green
- Whipps Cross Hospital, Barts NHS Trust, London, UK.
- Department of Health and Social Care, London South Bank University, London, UK.
| | - Cath Taylor
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
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Abstract
The population of adults with CHD continues to expand,and thus the number of women with CHD who contemplate pregnancy or become pregnant is also growing. Mothers with low-risk defects can be managed by general cardiologist,whereas those with more complex defects should be managed by or with the assistance of ACHD cardiologists. It is important to acknowledge that all patients with CHD may have unique anatomy or physiology, despite their classification as having a simple, moderate, or complex defect. As such, clinicians evaluating these patients should have adequate knowledge and expertise when assessing patient's risk for pregnancy,when performing imaging or hemodynamic studies, and when managing these patients during pregnancy. The American Board of Medical Specialties has recently recognized ACHD as a subspecialty of cardiovascular disease to treat the specialized needs of these patients in adulthood. ACHD experts can provide expertise in the management of specific defects or lesions, imaging techniques, prepregnancy risk assessment,and can manage these patients or comanage them with other medical providers during their pregnancy. Because many of these ACHD patients are lost to follow-up in adulthood, pregnancy represents a time when these patients seek medical care(and for some, represents a time of vulnerability and increased risk). This represents an opportunity to establish or reestablish care with ACHD specialists and to reestablish continuing long-term care for their CHD. Pregnancy also provides an opportunity to create partnerships between primary care physicians,adult cardiologists, and ACHD specialists to provide optimal care for these women throughout their lives.
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Affiliation(s)
- M Elizabeth Brickner
- From the University of Texas Southwestern Medical Center, Division of Cardiology, Dallas.
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Ng CHM, Fraser IS, Berbic M. Contraception for women with medical disorders. Best Pract Res Clin Obstet Gynaecol 2014; 28:917-30. [PMID: 25087667 DOI: 10.1016/j.bpobgyn.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article.
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Affiliation(s)
- Cecilia H M Ng
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| | - Ian S Fraser
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia.
| | - Marina Berbic
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
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Abstract
Maternal cardiac disease is a major cause of non-obstetric morbidity and accounts for 10-25% of maternal mortality. Valvular heart disease may result from congenital abnormalities or acquired lesions, some of which may involve more than one valve. Maternal and fetal risks in pregnant patients with valve disease vary according to the type and severity of the valve lesion along with resulting abnormalities of functional capacity, left ventricular function, and pulmonary artery pressure. Certain high-risk conditions are considered contraindications to pregnancy, while others may be successfully managed with observation, medications, and, in refractory cases, surgical intervention. Communication between the patient׳s obstetrician, maternal-fetal medicine specialist, obstetrical anesthesiologist, and cardiologist is critical in managing a pregnancy with underlying maternal cardiac disease. The management of the various types of valve diseases in pregnancy will be reviewed here, along with a discussion of related complications including mechanical prosthetic valves and infective endocarditis.
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Affiliation(s)
- Cara Pessel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St, PH-16, New York, NY 10032..
| | - Clarissa Bonanno
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St, PH-16, New York, NY 10032
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Drugs and therapeutics, including contraception, for women with heart disease. Best Pract Res Clin Obstet Gynaecol 2014; 28:471-82. [DOI: 10.1016/j.bpobgyn.2014.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/13/2014] [Indexed: 11/22/2022]
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Cartago RS, Alan PA, Benedicto J. Pregnancy outcomes in patients with severe pulmonary hypertension and Eisenmenger syndrome treated with sildenafil monotherapy. Obstet Med 2014; 7:40-2. [PMID: 27512419 PMCID: PMC4934936 DOI: 10.1177/1753495x13514403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pregnancy outcomes in patients with pulmonary arterial hypertension have not been documented in our local setting. In our institution, access to therapies like nitric oxide, inhaled prostacyclin and iloprost is limited. We describe two such women given sildenafil monotherapy between April and May 2011. Both had an atrial septal defect complicated by Eisenmenger syndrome. Both survived - one after elective Caesarean section for malpresentation (breech) under general anaesthesia, the other after an assisted vaginal delivery. In addition to oral sildenafil, both received oxygen supplementation. To date, there have been three reported cases of pulmonary arterial hypertension in pregnancy treated with sildenafil in combination with another drug. Our two cases demonstrate that treatment for pulmonary arterial hypertension using sildenafil as monotherapy may allow stabilization of the maternal condition and improve clinical outcomes for both mother and baby. However, pregnancy is still discouraged in women with pulmonary arterial hypertension.
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Affiliation(s)
- Reinalyn S Cartago
- Department of Internal Medicine, Las Pinas Doctors Hospital, Manila, Philippines
| | - Pichy Ann Alan
- Department of Internal Medicine Section Of Adult Cardiology, Philippine General Hospital, Manila, Philippines
| | - Jubert Benedicto
- Department of Internal Medicine Adult Pulmonary Medicine, Philippine General Hospital, Manila, Philippines
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Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study. BMC Pregnancy Childbirth 2014; 14:75. [PMID: 24552439 PMCID: PMC3943445 DOI: 10.1186/1471-2393-14-75] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/11/2014] [Indexed: 11/29/2022] Open
Abstract
Background The subject of “pregnancy and disease” is of particular importance for maternal well-being and neonatal outcomes. The international literature has focused on acute diseases during pregnancy; however, there are only a few studies investigating chronic diseases in pregnant women. The focus of this study is on diseases of women in childbearing age that are not related to the pregnancy. The objective of the paper is to deliver population based prevalences of chronic dieases in childbearing women and compare the two groups of chronically ill women and healthy women in detail regarding sociodemography, peri- and prenatal parameters and birth outcomes. Methods Data of n = 5320 childbearing women were evaluated in the context of the population-based Survey of Neonates in Pomerania (SNiP). Data were obtained via face-to-face interviews, self-applied questionnaires, and abstraction from medical records at the time of giving birth. Sociodemographic and health status data were assessed, including chronic diseases that were taken out of medical records. A comprehensive set of pre- and perinatal varaiables were assessed. Results In the SNiP, every fifth pregnant woman suffers from at least one chronic disease, and higher prevalence rates have been reported in the literature. There was a significant difference between chronically ill women and healthy women in age, education and income. Prenatal complications were more frequent in the healthy group than in the chronic disease group. Women with chronic diseases delivered by Cesarean section more frequently than women in the healthy group. Every tenth woman with at least one chronic disease gave birth to a premature infant, while only one in every 13 woman in the healthy control group gave birth to a premature infant. Conclusions This analysis is the first population-based study in which all chronic diseases could be taken into consideration. The population-based prevalences rates in the SNiP data are consistently lower than those found in the literature. There are differences between chronically ill women and healthy women in peri- and prenatal variables as well as birth outcome on the population level. However, they are less frequent than expected and further analyses are need focusing on specific diseases.
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Sawant RD, Freeman LJ, Stanley KP, McKelvey A. Pregnancy and treatment outcome in a patient with left ventricular non-compaction. Eur J Heart Fail 2014; 15:592-5. [DOI: 10.1093/eurjhf/hft002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Rahul D. Sawant
- Department of Cardiology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane Norwich NR4 7UY UK
| | - Leisa J. Freeman
- Department of Cardiology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane Norwich NR4 7UY UK
| | - Katherine P.S. Stanley
- Department of Obstetric Medicine; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - Alistair McKelvey
- Department of Obstetric Medicine; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
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Harris RC, Fries MH, Boyle A, Adeniji-Adele H, Cherian Z, Klein N, John AS. Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care. CONGENIT HEART DIS 2014; 9:E204-11. [PMID: 24447432 DOI: 10.1111/chd.12163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
Abstract
With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans.
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Affiliation(s)
- Rachel C Harris
- Harvard Medical School, Massachusetts General Hospital, Boston, Mass, USA
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Van Tintelen JP, Pieper PG, Van Spaendonck-Zwarts KY, Van Den Berg MP. Pregnancy, cardiomyopathies, and genetics. Cardiovasc Res 2014; 101:571-8. [PMID: 24451172 DOI: 10.1093/cvr/cvu014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although familial forms of cardiomyopathy such as hypertrophic or dilated cardiomyopathy have been recognized for decades, it is only recently that much of the genetic basis of these inherited cardiomyopathies has been elucidated. This has provided important insights into the pathophysiological mechanisms underlying the disease phenotype. This increased knowledge and the availability of genetic testing has resulted in increasing numbers of mutation carriers who are being monitored, including many who are now of child-bearing age. Pregnancy is generally well tolerated in asymptomatic patients or mutation carriers with inherited cardiomyopathies. However, since pregnancy leads to major physiological changes in the cardiovascular system, in women with genetic cardiomyopathies or who carry a mutation pre-disposing to a genetic cardiomyopathy, pregnancy entails a risk of developing heart failure and/or arrhythmias. This deterioration of cardiac function may occur despite optimal medical treatment. Advanced left ventricular dysfunction, poor functional class (NYHA class III or IV), or prior cardiac events appear to increase the risk of maternal cardiac complications. However, there are no large series of cardiomyopathy patients who are regularly evaluated for cardiac complications during pregnancy and for certain types of inherited cardiomyopathy, only case reports on individual pregnancies are available. Pre-conception cardiologic evaluation and genetic counselling are important for every woman with a cardiomyopathy or a cardiomyopathy-related mutation who is considering having a family. In this article, we give an overview of the basic clinical aspects, genetics, and pregnancy outcome in women with different types of inherited cardiomyopathies. We also discuss the genetic aspects of pregnancy-associated cardiomyopathy, including peripartum cardiomyopathy.
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Affiliation(s)
- J Peter Van Tintelen
- Department of Genetics, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, the Netherlands
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Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther 2014; 6:235-48. [DOI: 10.1586/14779072.6.2.235] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Newstead-Angel J, Gibson PS. Cardiac drug use in pregnancy: safety, effectiveness and obstetric implications. Expert Rev Cardiovasc Ther 2014; 7:1569-80. [DOI: 10.1586/erc.09.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Daudt NS, Zielinsky P. Late outcomes of congenital heart disease. Transl Pediatr 2013; 2:84-6. [PMID: 26835297 PMCID: PMC4728936 DOI: 10.3978/j.issn.2224-4336.2013.07.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In our days, more than 90% of children with congenital heart disease (CHD) reach adolescence and adult life, and therapeutic procedures are performed with late quality of life (QOL) in mind. Rates of success are now assessed at long range by sequels, residues and adaptation of the individuals to normality. The attempt to identify factors to avoid psychopathological sequels in this group of "new" cardiac patients is one of the most important aspects of studies on late outcome of congenital heart disease. This fact remains valid in the current era and is in consonance with the attitude to more and more value child-adolescent and adolescent-adult transitions in patients with CHD submitted or not to surgical or percutaneous intervention in childhood. Resilience and ability to adapt could also be improved by a multiprofessional approach of attitudes, abilities and psychological characteristics, aiming to prevent the psychopathologic effects of the disease.
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Affiliation(s)
- Nestor Santos Daudt
- Division of Pediatric Cardiology, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Zielinsky
- Division of Pediatric Cardiology, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
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Karasoy D, Bo Jensen T, Hansen ML, Schmiegelow M, Lamberts M, Gislason GH, Hansen J, Torp-Pedersen C, Olesen JB. Obesity is a risk factor for atrial fibrillation among fertile young women: a nationwide cohort study. ACTA ACUST UNITED AC 2013; 15:781-6. [DOI: 10.1093/europace/eus422] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nilofer AR, Zaki SA. Successful pregnancy in a patient with univentricular heart and pulmonary stenosis. Heart Views 2012; 13:71-3. [PMID: 22919452 PMCID: PMC3424783 DOI: 10.4103/1995-705x.99232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Univentricular heart or single ventricle heart is a rare and complex congenital heart disease (CHD). We report the successful management of a parturient with a single ventricle, and pulmonary stenosis. The univentricular heart is discussed in detail and the maternal and fetal outcome in pregnant women with CHD is reviewed.
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Affiliation(s)
- Angadi Rajasab Nilofer
- Department of Obstetrics and Gynaecology, J.J.M. Medical College, Davangere, Karnataka, India
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Wald RM, Sermer M, Colman JM. Pregnancy and contraception in young women with congenital heart disease: General considerations. Paediatr Child Health 2012; 16:e25-9. [PMID: 22468131 DOI: 10.1093/pch/16.4.e25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 11/13/2022] Open
Abstract
Young women with heart disease are increasingly being seen in obstetrical referral centres owing, in large part, to the dramatic improvements in survival of young adults with congenital heart disease in recent years. Although pregnancies in most women with heart disease result in favourable outcomes, there are important exceptions that must be recognized. These exceptions pose significant mortality risk to the mother and/or the fetus. The present article outlines cardiovascular adaptations to pregnancy, general outcomes and management considerations for practitioners caring for pregnant young women with congenital heart disease. A lesion-specific review is published in a complementary article.
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Affiliation(s)
- Rachel M Wald
- Toronto General Hospital, Mount Sinai Hospital and Toronto Congenital Cardiac Centre for Adults, University Health Network
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Wald RM, Sermer M, Colman JM. Pregnancy in young women with congenital heart disease: Lesion-specific considerations. Paediatr Child Health 2012; 16:e33-7. [PMID: 22547951 DOI: 10.1093/pch/16.5.e33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 11/14/2022] Open
Abstract
Young women with heart disease are increasingly being seen in obstetrical referral centres owing, in large part, to the dramatic improvements in survival of young adults with congenital heart disease in recent years. Although pregnancies in most women with heart disease result in favourable outcomes, there are important exceptions that must be recognized. These exceptions pose a significant mortality risk to the mother and/or the fetus. The present article provides a general framework for the classification of congenital heart lesions in pregnant women as well as a detailed lesion-specific review.
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Affiliation(s)
- Rachel M Wald
- Toronto General Hospital, Mount Sinai Hospital and Toronto Congenital Cardiac Centre for Adults, University Health Network
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Abstract
Cardiac arrest in pregnancy is a rare event, and the speed of resuscitation response is critical to the outcome of both the mother and the fetus. The management of the unresponsive pregnant woman differs from that of the traditional adult resuscitation. In this article, causes of maternal arrest, management of proper cardiopulmonary arrest in pregnancy, and implementation of perimortem cesarean delivery are discussed.
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Abstract
UNLABELLED Valvular heart disease is common in pregnancy. Maternal physiology changes significantly during gestation with substantial increases in cardiac output and blood volume; this can cause unmasking or worsening of cardiac disease. Acquired valvular lesions most frequently arise from rheumatic fever, especially in patients who have emigrated from developing nations. Congenital lesions are also encountered. The most common conditions seen, mitral stenosis and regurgitation and aortic stenosis and regurgitation, each require a specific evaluation and management and are associated with their own set of possible complications. Patients with prosthetic valves require anticoagulation, and maternal and fetal risks and benefits must be carefully weighed. Patients with heart disease should be meticulously managed preconceptionally up to the postpartum period by maternal-fetal medicine specialists, obstetricians, cardiologists, and anesthesiologists using a multi-disciplinary approach to their cardiac conditions. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After the completing the CME activity, physicians should be better able to examine the epidemiology of valvular heart disease in pregnancy, categorize key physiologic parameters that change in the cardiovascular system during pregnancy, classify the pathophysiology of valvular lesions, and evaluate the general principles of maternal and fetal management for cardiac disease.
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Michaelson-Cohen R, Elstein D, Ioscovich A, Armon S, Schimmel MS, Butnaru A, Samueloff A, Grisaru-Granovsky S. Severe heart disease complicating pregnancy does not preclude a favourable pregnancy outcome: 15 years' experience in a single centre. J OBSTET GYNAECOL 2012; 31:597-602. [PMID: 21973131 DOI: 10.3109/01443615.2011.603064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Heart disease (HD) in pregnancy remains a major cause of non-obstetric maternal and neonatal mortality and morbidity. This study describes the outcome in 164 pregnant women with HD (158 deliveries in women in New York Heart Association (NYHA) Classes 1 and 2; 17 in NYHA Classes 3 and 4) who received good antenatal care and benefitted from a specific protocol and experience of a dedicated staff. There were no maternal or neonatal deaths; 46 women were diagnosed peripartum. Based on a sub-division into NYHA categories, and when sub-divided by HD, there were no statistically significant differences between groups with regard to maternal age, gestational age at admission or at delivery, birth weight, 5 min Apgar scores, mode of delivery (caesarean delivery), senior obstetric/anaesthesiology staff in attendance or delivery during day/working hours. There was a higher incidence of pre-term deliveries in women with rheumatic heart disease and Marfan syndrome (p = 0.06) relative to others. Babies of women with coronary heart disease had prolonged postpartum course in the NICU (p = 0.0001) and longer total hospital stays for the mother. In conclusion, well-managed, motivated mothers with HD who benefit from comprehensive antenatal care, and are managed primarily by their obstetric and anaesthesia teams, can aspire to a good outcome for themselves and their babies.
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Affiliation(s)
- R Michaelson-Cohen
- Department Obstetrics and Gynecology, Hebrew University of Jerusalem, Shaare Zedek Medical Centre, Jerusalem, Israel
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