1
|
Sato T, Ogihara Y, Nakaya H, Sugiura E, Okamoto R, Furuhashi F, Nii M, Toriyabe K, Ikeda T, Dohi K. Management of pulmonary hemodynamics prior to delivery in a pregnant woman with development of decompensated pulmonary arterial hypertension. J Cardiol Cases 2024; 29:55-58. [PMID: 38362581 PMCID: PMC10865132 DOI: 10.1016/j.jccase.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 02/17/2024] Open
Abstract
Prompt termination of pregnancy in patients with decompensated pulmonary arterial hypertension (PAH) is imperative for improvement of maternal hemodynamics, but such termination may also result in maternal death due to further deterioration of PAH immediately after delivery. However, there have been limited reports on whether implementation of PAH therapy with continuation of pregnancy improves the maternal outcome, especially in treatment-naïve patients with PAH. A 24-year-old woman was admitted to our hospital with a chief complaint of dyspnea (WHO functional class IV) at 22 weeks and 3 days of gestation. She was diagnosed with PAH accompanied by right heart failure and low cardiac output. Intensive treatment was initiated with inotropic agents, oxygen therapy, and PAH therapy, resulting in improvement of her hemodynamics. A caesarean section was performed at 23 weeks and 3 days. Although her pulmonary arterial pressure transiently increased with oxygenation deteriorating immediately after delivery, worsening PAH improved without mechanical circulatory support. She continued receiving pulmonary vasodilators without relapse of pulmonary hypertension for three years. The improvement of pulmonary hemodynamics prior to delivery with PAH therapy led to a favorable outcome after delivery. Learning objective Pulmonary hemodynamics in pregnant patients with pulmonary arterial hypertension (PAH) can deteriorate with the continuation of pregnancy, while termination can also cause PAH surge immediately after delivery. In treatment-naïve patients with PAH, who are most likely to benefit from PAH therapy, implementation of PAH therapy with continuation, even with a decompensated status, may improve the hemodynamics prior to delivery, resulting in a favorable outcome after delivery.
Collapse
Affiliation(s)
- Toru Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hitoshi Nakaya
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Emiyo Sugiura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Fumi Furuhashi
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
2
|
Tanaka A, Higeta D, Arai S, Ishibashi Y, Kyoya T, Iwase A. Single coronary artery diagnosed in the perinatal period: A case report. Taiwan J Obstet Gynecol 2023; 62:562-565. [PMID: 37407195 DOI: 10.1016/j.tjog.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Having a single coronary artery (SCA) is a rare congenital anomaly in which a single artery arises from the aorta. Although most cases of SCA are asymptomatic and incidental, its effects during the perinatal period remain unknown. Herein, we report a case of pregnant woman with suspected SCA, based on transthoracic echocardiography (TTE) findings. CASE REPORT A 33-year-old multiparous woman presented with preterm premature rupture of the membrane at 29 weeks gestation. The patient's preoperative electrocardiogram (ECG) showed slight ST changes. TTE showed dilated right coronary artery and hypoplastic left coronary artery. Cesarean section was performed at 30 weeks of gestation due to non-reassuring fetal status. Although poor oxygenation was observed postoperatively, the patient was managed appropriately. She was diagnosed with SCA based on coronary computed tomographic angiography findings one month after delivery. CONCLUSION Pregnant women with SCA require careful perinatal care.
Collapse
Affiliation(s)
- Ayuko Tanaka
- Department of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Daisuke Higeta
- Department of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Gunma, Japan.
| | - Syuhei Arai
- Department of Cardiology, Gunma Children's Medical Center, Shibukawa, Gunma, Japan
| | - Yohei Ishibashi
- Department of Cardiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Takuji Kyoya
- Department of Obstetrics, Gunma Children's Medical Center, Shibukawa, Gunma, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Gunma, Japan
| |
Collapse
|
3
|
Omidi N, khorgami M, khatami F, Mahalleh M. Electrocardiographic indices and pregnancy: A focus on changes between first and third trimesters. Rev Port Cardiol 2022; 41:43-47. [DOI: 10.1016/j.repc.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 10/19/2022] Open
|
4
|
Keepanasseril A, Pfaller B, Metcalfe A, Siu SC, Davis MB, Silversides CK. Cardiovascular Deaths in Pregnancy: Growing Concerns and Preventive Strategies. Can J Cardiol 2021; 37:1969-1978. [PMID: 34600086 DOI: 10.1016/j.cjca.2021.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
There has been an increase in maternal deaths from cardiovascular disease in many countries. In high-income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve disease are responsible for up to one-third of all pregnancy-related maternal deaths. In low- and middle-income countries, rheumatic heart disease is a much more common cause of cardiac death during pregnancy. Although deaths occur in women with known heart conditions or cardiovascular risk factors such as hypertension, many women present for the first time in pregnancy with unrecognised heart disease or with de novo cardiovascular conditions such as preeclampsia, peripartum cardiomyopathy, spontaneous coronary artery dissection. Not only has maternal cardiovascular mortality increased, but serious cardiac morbidity, or "near misses," during pregnancy also have increased in frequency. Although maternal morbidity and mortality are often preventable, many health professionals remain unaware of the impact of cardiovascular disease in this population, and the lack of awareness contributes to inappropriate care and preventable deaths. In this review, we discuss the maternal mortality from cardiovascular causes in both high- and low- and middle-income countries and strategies to improve outcomes.
Collapse
Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Birgit Pfaller
- Department of Internal Medicine 1, University Hospital of St Pölten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology, St Pölten, Austria
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Department of Community Health Sciences and Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel C Siu
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University of Western Ontario, London, Ontario, Canada
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Candice K Silversides
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
5
|
Abe I, Wang P, Takahashi M, Ohno S, Ono K, Takahashi N. Familial sick sinus syndrome possibly associated with novel SCN5A mutation diagnosed in pregnancy. HeartRhythm Case Rep 2021; 7:117-122. [PMID: 33665115 PMCID: PMC7897738 DOI: 10.1016/j.hrcr.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Ichitaro Abe
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Pu Wang
- Department of Pathophysiology, Faculty of Medicine, Oita University, Oita, Japan.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Katsushige Ono
- Department of Pathophysiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
6
|
Chien SJ, Lin YJ, Lo MH, Huang CF, Yang YH. Congenital Heart Diseases Impair Female Fertility. Front Pediatr 2021; 9:687276. [PMID: 34336741 PMCID: PMC8316762 DOI: 10.3389/fped.2021.687276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The objective of this research was to evaluate the fertility of Taiwanese women with diagnoses of congenital heart diseases (CHDs). The study also investigated how different forms of CHDs may have variously influenced fertility. Methods: We directed this nationwide, population-based and retrospective matched-cohort research by using data from the Taiwan National Health Insurance Research Database. The CHD group (n = 6602) included women with congenital structural heart diseases, aged 16-45 years in 2000. The non-CHD group (n = 6602) was matched according to urbanization and income. The outcomes, involving live birth, abortion, and fertility rates, were followed until the end of 2013. Poisson regression was used to evaluate the incidence rate ratios (IRRs). Results: The CHDs had an inferior rate of live births (IRR 0.74 [95% CI 0.71-0.78]) than the non-CHD group. There was also a lower fertility rate in the CHD group (IRR 0.81 [95% CI 0.78-0.84]) than the non-CHD group. Abortion rates between the two groups were similar. Conclusion: Congenital structural heart disease compromises female fertility, even among patients with simple forms of CHDs. It is suggested that pregnant patients with CHDs are early appeared to and advised personally with multidisciplinary care to improve their outcomes.
Collapse
Affiliation(s)
- Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.,Department of Early Childhood Care and Education, Cheng Shiu University, Kaohsiung, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Mao-Hung Lo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chien-Fu Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory of Chang Gung, Memorial Hospital Chiayi, Chiayi, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial, Hospital Chiayi, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
7
|
Yuliyanti S, Utarini A, Trisnantoro L. A protocol study of participatory action research: integrated care pathway for pregnant women with heart disease in Indonesia. BMC Health Serv Res 2020; 20:932. [PMID: 33036607 PMCID: PMC7547524 DOI: 10.1186/s12913-020-05769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Heart diseases are increasingly identified as an important indirect cause of maternal mortality in several cities in Indonesia. The management of pregnancy with heart diseases requires a multidisciplinary approach, and interprofessional collaboration practice (IPCP) is critical to improving the quality of patient care. To enable the effective implementation of IPCP, integrated care pathways (ICPs) are needed to define the roles and responsibilities of the health professionals involved. This study aims to examine the obstacles and enabling factors of IPCP, to develop and use ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. METHODS A participatory action study consisting of four stages (diagnostic, planning, implementation, and evaluation) will take approximately 2 years after consensus of ICPs are made. The primary data collection process will employ consensus, observations, focus group discussions, and in-depth interviews throughout the four stages, while secondary data from referral documents and medical records will be collected mainly during the diagnostic and evaluation stages. The findings are being analysed and will then be used to develop an ICPs through consensus building at the planning stage to be applied in the implementation stage. Finally, the implementation outcome, including acceptability, adoption, appropriateness, and feasibility of IPCP, will be assessed in the evaluation stage. All qualitative data will be analysed thematically by two coders using NVIVO 12 software. DISCUSSION This research aims to assess the needs of IPCP, develop and use the ICPs in the implementation of IPCP in health care services for pregnant women with heart diseases. Findings from this study will be used for health service planning and policy making to strengthen practice of IPCP during the referral process. As a result, pregnant women with heart disease will have better access to high-quality services at every health care facility to reduce maternal mortality. TRIAL REGISTRATION Retrospectively registered in the ISRCTN registry with study ID ISRCTN82300061 on Feb 6, 2019.
Collapse
Affiliation(s)
- Suryani Yuliyanti
- Public Health Department, Faculty of Medicine, Universitas Islam Sultan Agung, Jl. Kaligawe Raya km 4, Semarang, 50122 Indonesia
- Doctoral Study Programme, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Adi Utarini
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| | - Laksono Trisnantoro
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako Sekip Utara, Yogyakarta, Sinduadi, Mlati, Special Region of Yogyakarta 55281 Indonesia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Aratake S, Yasuda A, Sawamura S. Cesarean section under spinal anesthesia in acquired complete atrioventricular block without a pacemaker: A case report. Clin Case Rep 2019; 7:1663-1666. [PMID: 31534722 PMCID: PMC6745382 DOI: 10.1002/ccr3.2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/22/2019] [Indexed: 11/10/2022] Open
Abstract
Pregnancy with complete atrioventricular block is rare, and its perioperative management is controversial. We successfully managed cesarean section in a pregnancy with acquired complete atrioventricular block under spinal anesthesia without a pacemaker. Asymptomatic pregnant women with acquired complete atrioventricular block can tolerate cesarean section under spinal anesthesia without a pacemaker.
Collapse
Affiliation(s)
- Shungo Aratake
- Department of AnesthesiologyTeikyo University School of MedicineTokyoJapan
| | - Atsushi Yasuda
- Department of AnesthesiologyTeikyo University School of MedicineTokyoJapan
| | - Shigehito Sawamura
- Department of AnesthesiologyTeikyo University School of MedicineTokyoJapan
| |
Collapse
|
10
|
Author’s reply to “Anticoagulation strategy and management of patients with mechanical prosthetic heart valves during pregnancy”. J Cardiol Cases 2019; 20:71. [DOI: 10.1016/j.jccase.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Indexed: 11/16/2022] Open
|
11
|
Hakata S, Umegaki T, Soeda T, Nishimoto K, Ando A, Anada N, Uba T, Sumi C, Kamibayashi T. Bromocriptine use for sudden peripartum cardiomyopathy in a patient with preeclampsia: a case report. JA Clin Rep 2019; 5:38. [PMID: 32026046 PMCID: PMC6966983 DOI: 10.1186/s40981-019-0256-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function. Case presentation The patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/μL on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old and treated with prednisolone at 15 mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2 days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24 days after surgery. Conclusion A sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.
Collapse
Affiliation(s)
- Saya Hakata
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Takehiro Soeda
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Kota Nishimoto
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Akiko Ando
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Natsuki Anada
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takeo Uba
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Chisato Sumi
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takahiko Kamibayashi
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| |
Collapse
|
12
|
Tanaka H, Kamiya C, Katsuragi S, Tanaka K, Yoshimatsu J, Ikeda T. Effect of epidural anesthesia in labor; pregnancy with cardiovascular disease. Taiwan J Obstet Gynecol 2018; 57:190-193. [PMID: 29673659 DOI: 10.1016/j.tjog.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE We studied the effect and safety of epidural anesthesia during labor in pregnant women with cardiovascular disease. MATERIALS AND METHODS In the pregnant women with cardiovascular disease, we compared maternal outcome and suppressive effect on blood pressure retrospectively between the epidural group (anesthetized epidurally during labor) and the no-epidural group (not anesthetized epidurally during labor). RESULTS A total of 277 patients were included in the analyses. Cardiovascular events decreased significantly in epidural group (P < 0.05). Cardiovascular events occurred in 12 (epidural group) and 2 (no-epidural group) of cases (P < 0.05). Cardiovascular events are all events related to arrhythmia. In the epidural group, the systolic blood pressure showed no increase in labor (110.5 mmHg, 95% CI; 95-132 mmHg vs. 110 mmHg, 95% CI; 91-130 mmHg). In the no-epidural group, the systolic blood pressure increased in labor (107 1 mmHg, 95% CI; 96-138 mmHg vs. 123 mmHg, 95% CI; 105-153 mmHg; P < 0.05). CONCLUSION Epidural anesthesia had decrease of the cardiovascular events related to arrhythmia and the effect of significantly suppression raising the blood pressure during labor in pregnant women with cardiovascular disease. In pregnant women with the cardiovascular disease, epidural anesthesia during labor may be available.
Collapse
Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan.
| | - Chizuko Kamiya
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Shinji Katsuragi
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Jun Yoshimatsu
- Department of Perinatology, National Cerebral and Cardiovascular Center, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| |
Collapse
|
13
|
Ueda Y, Kamiya CA, Horiuchi C, Miyoshi T, Hazama R, Tsuritani M, Iwanaga N, Neki R, Ikeda T, Yoshimatsu J. Safety and efficacy of a 52-mg levonorgestrel-releasing intrauterine system in women with cardiovascular disease. J Obstet Gynaecol Res 2018; 45:382-388. [PMID: 30259601 DOI: 10.1111/jog.13828] [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] [Received: 04/11/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022]
Abstract
AIM We sought to examine the safety and efficacy of a 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS), and to evaluate the changes in biomarkers of infection, anemia and cardiovascular conditions after LNG-IUS insertion in women with cardiovascular disease. METHODS We prospectively followed women with a cardiovascular disease in whom a 52-mg LNG-IUS was inserted between 2009 and 2015. The primary outcome was the frequency of cardiovascular and gynecologic side effects due to the LNG-IUS over the year after LNG-IUS insertion. The secondary outcomes were the changes in menstrual blood loss and biomarkers, e.g., white blood cell count and the levels of C-reactive protein, hemoglobin and brain natriuretic peptide. We also evaluated the 24-month continuation rate of LNG-IUS. RESULTS A total of 34 women were prospectively followed-up, including two women with pulmonary hypertension. No cardiovascular side effects were identified during the 1 year after LNG-IUS insertion, other than one case of mild vasovagal reaction at insertion. Neither the white blood cell count nor the C-reactive protein value increased after LNG-IUS insertion. The menstrual blood loss was decreased in most subjects and the median hemoglobin levels increased significantly within 1 year after insertion (P < 0.001 and P = 0.002). Moreover, brain natriuretic peptide levels tended to decrease in correspondence with the hemoglobin elevation (P = 0.074). The 24-month LNG-IUS continuation rate was 97% (95% confidence interval 85-100). CONCLUSION No clinically significant cardiovascular event was identified during the 1 year after 52-mg LNG-IUS insertion among women with cardiovascular disease. The 52-mg LNG-IUS may have specific favorable effects by decreasing the risk of iron deficiency anemia in these women.
Collapse
Affiliation(s)
- Yusuke Ueda
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chizuko A Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chinami Horiuchi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takekazu Miyoshi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryoichi Hazama
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mitsuhiro Tsuritani
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoko Iwanaga
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Reiko Neki
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
14
|
Komatsu T, Motoki H, Kimura K, Saigusa T, Ebisawa S, Yokokawa Y, Ando H, Ichino T, Kuwahara K. A case of thrombolytic therapy with recombinant tissue plasminogen activator for mechanical valve thrombosis at 9 weeks of pregnancy in a Japanese woman. J Cardiol Cases 2018; 19:15-18. [PMID: 30693052 DOI: 10.1016/j.jccase.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022] Open
Abstract
A 29-year-old woman was admitted to our hospital due to diagnosis of pregnancy at 5 weeks and a day. She underwent valve replacement with mechanical heart valve (MHV: SJM valve) for congenital mitral valve regurgitation, when 11 years old. Warfarin 4 mg was used for anticoagulation. After admission, warfarin was replaced by unfractionated heparin (UFH). She developed exertional dyspnea at 8 weeks of pregnancy. Echocardiogram and fluoroscopy showed an immobile leaflet in the closed position. She was diagnosed with mechanical valve thrombosis. Cardiac surgery or thrombolytic therapy (TT) were treatment options. TT is not established, but is reported to be safer than cardiac surgery. Recently, low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) therapy showed acceptable results. About 2.5 h after an intravenous injection of rt-PA, diastolic rumble improved to the normal range of leaflet. Thereafter, warfarin was restarted and there was no recurrence of symptoms and no abortion. She was readmitted for the scheduled Caesarean section (CS) at 32 weeks of pregnancy, and warfarin was replaced with UFH. At 34 weeks of pregnancy, a baby was delivered by CS. She suffered hemostasis after surgery under the anticoagulation. Postoperative day 31, both mother and a child were healthy and left the hospital. <Learning objective: The coagulation status is activated and the fibrinolytic activity is reduced during pregnancy. Prosthetic valve thrombosis during pregnancy is known as a life-threatening event for mother and fetus. The treatment strategy for this complication is not well established. Low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) therapy showed acceptable results. This case report shows that rt-PA therapy for the prosthetic valve thrombosis in a Japanese pregnancy woman could be an alternative treatment strategy to surgery.>.
Collapse
Affiliation(s)
| | - Hirohiko Motoki
- Division of Cardiology, Shinshu University Hospital, Nagano, Japan
| | - Kazuhiro Kimura
- Division of Cardiology, Shinshu University Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Division of Cardiology, Shinshu University Hospital, Nagano, Japan
| | - Soichiro Ebisawa
- Division of Cardiology, Shinshu University Hospital, Nagano, Japan
| | - Yusuke Yokokawa
- Division of Obstetrics and Gynecology, Shinshu University Hospital, Nagano, Japan
| | - Hirofumi Ando
- Division of Obstetrics and Gynecology, Shinshu University Hospital, Nagano, Japan
| | - Takashi Ichino
- Division of Anesthesiology and Resuscitology, Shinshu University Hospital, Nagano, Japan
| | | |
Collapse
|
15
|
A Case of a Pregnant Woman with Thrombosis in an Artificial Aortic Valve Resulting in Severe Cerebral Hemorrhage in the Newborn. Case Rep Obstet Gynecol 2018; 2018:6154382. [PMID: 30151288 PMCID: PMC6087570 DOI: 10.1155/2018/6154382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/15/2018] [Indexed: 11/17/2022] Open
Abstract
Many patients, after artificial valve replacement surgery, receive warfarin anticoagulant therapy. However, it has been reported that warfarin administration during pregnancy can cause fetal teratogenicity. With reference to this case, we will discuss how warfarin administration in mid-pregnancy caused severe cerebral hemorrhage in the newborn child. The 36-year-old patient in this case underwent aortic valve replacement surgery when she was 11 years old; this requires the continued use of warfarin after surgery. Although she was advised otherwise, the patient became pregnant. The warfarin treatment was discontinued at 5 weeks of gestation and she began self-injection of heparin; however, her health quickly deteriorated requiring an emergency, warfarin treatment. On gestation week 21, she was admitted to our hospital with a high likelihood of a spontaneous abortion. A week later, transesophageal ultrasonography revealed a thrombus in the patient's aortic valve. Because of this finding, we re-started warfarin administration. At 32 weeks of gestation, cardiotocography showed decreased fetal heart rate; thus, an emergency Cesarean section was performed. A baby was delivered, weighing 1,702 g with an Apgar Score of 1 at 1 minute and 4 at 5 minutes. Cranial computed tomography of the infant showed bilateral intraventricular hemorrhage and ventricular dilation. In order to protect the mother and prevent hemorrhage in the newborn, it is recommended that a continuous heparin infusion should be administered to the pregnant woman after the 36th week of gestation. Regarding the impact on the infant, it is considered that continuous intravenous administration of heparin is safer during the third trimester of pregnancy. However, administration of heparin alone makes the preventive effect of thrombosis uncertain. When warfarin is administered in pregnancy, pregnancy management should be performed bearing the risk of fetal cerebral hemorrhage in mind.
Collapse
|
16
|
Kanoh M, Inai K, Shinohara T, Shimada E, Shimizu M, Tomimatsu H, Ogawa M, Nakanishi T. Influence of pregnancy on cardiac function and hemodynamics in women with Ebstein's anomaly. Acta Obstet Gynecol Scand 2018; 97:1025-1031. [DOI: 10.1111/aogs.13373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Miki Kanoh
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Kei Inai
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Mikiko Shimizu
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Hirofumi Tomimatsu
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Masaki Ogawa
- Department of Obstetrics and Gynecology; Tokyo Women's Medical University; Tokyo Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| |
Collapse
|
17
|
Mayer F, Bick D, Taylor C. Multidisciplinary care for pregnant women with cardiac disease: A mixed methods evaluation. Int J Nurs Stud 2018; 85:96-105. [PMID: 29879624 DOI: 10.1016/j.ijnurstu.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac disease is associated with adverse outcomes in pregnancy and is the leading cause of indirect maternal death in the United Kingdom (UK) and internationally. National and international guidelines recommend women should receive care from multidisciplinary teams; however evidence is lacking to inform how they should be operationalised. OBJECTIVES To describe the composition and processes of multidisciplinary care between maternity and cardiac services before, during and after pregnancy for women with cardiac disease, and explore clinicians' (cardiologists, obstetricians, nurses, midwives) and women's experiences of delivering/receiving care within these models. DESIGN Mixed-methods comprising case-note audit, interviews and observation. SETTING Two inner-city National Health Service (NHS) maternity units in the south of England serving similar obstetric populations, selected to represent different models of multidisciplinary team care. PARTICIPANTS Women with significant cardiac disease (either arrhythmic or structural, e.g. tetralogy of fallot) who gave birth between June 1 st 2014 and 31 st May 2015 (audit/interviews), or attended an multidisciplinary team clinic (obstetric/cardiac) during April 2016 (observation). METHODS A two-phase sequential explanatory design was undertaken. A retrospective case-note audit of maternity and medical records (n = 42 women) followed by interviews with a sub-sample (n = 7 women). Interviews were conducted with clinicians (n = 7) and observation of a multidisciplinary team clinic in one site (n = 8 women, n = 4 clinicians). RESULTS The interests and expertise of individual clinicians employed by the hospital trusts influenced the degree of integration between cardiac and maternity care. Integration between cardiac and maternity services varied from an ad-hoc 'collaborative' model at Site B to an 'interdisciplinary' approach at Site A. In both sites there was limited documented evidence of individualised postnatal care plans in line with national guidance. Unlike pathways for risk assessment, referral and joined care in pregnancy for women with congenital cardiac disease, pathways for women with acquired conditions lacked clarity. Midwives at both sites were often responsible for performing the initial maternal cardiac risk assessment despite minimal training in this. Clinicians and women's perceptions of 'normality' in pregnancy/birth, and its relationship to 'safe' maternity care were at odds. CONCLUSION The limited evidence and guidance to support multidisciplinary team working for pregnancy in women with cardiac disease - particularly those with acquired conditions - has resulted in variable models and pathways of care. Evidence-based guidance regarding the operationalisation of integrated care between maternity and cardiac services - including pathways between local and specialist centres - for all women with cardiac disease in pregnancy is urgently required.
Collapse
Affiliation(s)
- Felicity Mayer
- South West London & St George's Mental Health NHS Trust, UK
| | - Debra Bick
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, UK.
| |
Collapse
|
18
|
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]
|
19
|
Nakamura M, Kita S, Kikuchi R, Hirata Y, Shindo T, Shimizu N, Inuzuka R, Oka A, Kamibeppu K. A Qualitative Assessment of Adolescent Girls' Perception of Living with Congenital Heart Disease: Focusing on Future Pregnancies and Childbirth. J Pediatr Nurs 2018; 38:e12-e18. [PMID: 29153935 DOI: 10.1016/j.pedn.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Congenital heart disease (CHD) is the most common birth anomaly in Japan, occurring in approximately 10.6 of every 1,000 live births. Advancements in medical and surgical care have increased births by women diagnosed with CHD. The study's purpose was to examine the perceptions of pregnancy and childbirth among adolescent girls with CHD. DESIGN AND METHODS Twelve semi-structured interviews were conducted, and the data were analyzed using a modified grounded-theory approach. RESULTS Three categories and 16 subcategories were extracted. Adolescent girls with CHD reported feelings of distress and anxiety while struggling with their disease, and feared how their disease might negatively influence their future pregnancy. These concerns were related to a desire to become familiar with CHD. The girls also explored how their disease would be managed during pregnancy and childbirth. Overall, these perceptions were influenced by the girls' acceptance of their disease, and support from family, friends, and healthcare professionals. CONCLUSIONS Healthcare professionals might assess adolescent girls' awareness of their disease before discussing pregnancy and childbirth risks. To encourage them to understand and cope with their disease, healthcare professionals might provide interventions tailored to the timing, stage, and degree of pregnancy and childbirth awareness. This could allow safer life planning, especially concerning pregnancy and childbirth decisions. PRACTICE IMPLICATIONS To address adolescent girls' needs, healthcare professionals should continuously assess their awareness of pregnancy and childbirth as well as their psychological status, alongside CHD issues.
Collapse
Affiliation(s)
- Mayumi Nakamura
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | | | | | | | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo, Japan.
| | - Akira Oka
- Department of Pediatrics, The University of Tokyo, Japan.
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| |
Collapse
|
20
|
Niwa K. Adult Congenital Heart Disease with Pregnancy. Korean Circ J 2018; 48:251-276. [PMID: 29625509 PMCID: PMC5889976 DOI: 10.4070/kcj.2018.0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022] Open
Abstract
The number of women with congenital heart disease (CHD) at risk of pregnancy is growing because over 90% of them are grown-up into adulthood. The outcome of pregnancy and delivery is favorable in most of them provided that functional class and systemic ventricular function are good. Women with CHD such as pulmonary hypertension (Eisenmenger syndrome), severe left ventricular outflow stenosis, cyanotic CHD, aortopathy, Fontan procedure and systemic right ventricle (complete transposition of the great arteries [TGA] after atrial switch, congenitally corrected TGA) carry a high-risk. Most frequent complications during pregnancy and delivery are heart failure, arrhythmias, bleeding or thrombosis, and rarely maternal death. Complications of fetus are prematurity, low birth weight, abortion, and stillbirth. Risk stratification of pregnancy and delivery relates to functional status of the patient and is lesion specific. Medication during pregnancy and post-delivery (breast feeding) is a big concern. Especially prescribing medication with teratogenicity should be avoidable. Adequate care during pregnancy, delivery, and the postpartum period requires a multidisciplinary team approach with cardiologists, obstetricians, anesthesiologists, neonatologists, nurses and other related disciplines. Caring for a baby is an important issue due to temporarily pregnancy-induced cardiac dysfunction, and therefore familial support is mandatory especially during peripartum and after delivery. Timely pre-pregnancy counseling should be offered to all women with CHD to prevent avoidable pregnancy-related risks. Successful pregnancy is feasible for most women with CHD at relatively low risk when appropriate counseling and optimal care are provided.
Collapse
Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan. ,
| |
Collapse
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
Koerten MA, Niwa K, Szatmári A, Hajnalka B, Ruzsa Z, Nagdyman N, Niggemeyer E, Peters B, Schneider KTM, Kuschel B, Mizuno Y, Berger F, Kaemmerer H, Bauer UMM. Frequency of Miscarriage/Stillbirth and Terminations of Pregnancy Among Women With Congenital Heart Disease in Germany, Hungary and Japan. Circ J 2016; 80:1846-51. [PMID: 27334027 DOI: 10.1253/circj.cj-15-1296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The 2011 guidelines of the European Society of Cardiology (ESC) on the management of cardiovascular diseases during pregnancy define the maternal predictors for neonatal complications. The aim of this study was to determine whether these are associated with an increased number of miscarriages/stillbirths and terminations of pregnancy (TOPs) also in patients with congenital heart defects (CHD). METHODS AND RESULTS The 634 women from Germany, Hungary and Japan were surveyed concerning the issues of sexuality and reproductive health, as well as their general life situation and medical care. 25% of the recorded pregnancies in women with CHD resulted in miscarriage, stillbirth or TOP. Affecting 16.8% of all recorded pregnancies, miscarriages or stillbirths occurred more frequently than in the general population and more than previously recorded for patients with CHD. TOP occurred in 8% of the surveyed pregnancies. Underlying maternal predictors for neonatal events had an influence on the number of TOP; among those with underlying predictors, TOP was recorded 3-fold more than in those without such predictors (15.6% vs. 5.5%). Remarkably, a significant deficit regarding the level of information on potential pregnancy-associated risks was observed in all 3 participating countries. CONCLUSIONS Pregnant women with CHD should always be treated and counseled individually by cardiologists, gynecologists, obstetricians and anesthetists with appropriate expert knowledge. (Circ J 2016; 80: 1846-1851).
Collapse
Affiliation(s)
- Marc-André Koerten
- German Heart Centre Munich, Department of Paediatric Cardiology and Congenital Heart Defects, Technical University of Munich
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, Yoshimatsu J, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T. The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012. J Cardiol 2016; 69:74-78. [PMID: 26899278 DOI: 10.1016/j.jjcc.2016.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/30/2015] [Accepted: 01/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD), both genetic and acquired, increase the risk of maternal death (MD) unless proper genetic/clinical counseling is provided and a multidisciplinary approach is adopted during pregnancy. In recent decades, there has been a significant increase in the number of women with CVD of child-bearing age and in the incidence of pregnancy among relatively older women. However, the impact of this phenomenon on MD has not been carefully investigated. METHODS This retrospective study compares the incidence and etiology of maternal deaths related to cardiovascular disease (MD-CVD) in Japan in 2010-2012 to that seen in 1991-1992. RESULTS Seven cases of MD-CVD were reported in 1991-1992, compared to 15 in 2010-2012. In 2010-2012, the causes included aortic dissection (n=5), peripartum cardiomyopathy (n=3), sudden adult/arrhythmic death syndrome (n=2), acute cardiomyopathy (n=2), pulmonary hypertension (n=2), and myocardial infarction (n=1), and four of these causes were not encountered in 1991-1992. The incidence of MD over the total number of pregnancies decreased from 9.4 per 100,000 cases in 1990-1992 to 4.6 per 100,000 cases in 2010-2012 (p<0.05). However, the incidence of MD-CVD over the number of cases of MD increased from 2.9% in 1991-1992 to 9.7% in 2010-2012 (p<0.05). CONCLUSIONS The present study demonstrates that the rate of MD-CVD among the cases of MD has increased 3-fold in Japan over the past 20 years. Thus, it is of critical importance to better understand the etiologies and early signs of MD-CVD and to devise an effective management program for pregnancies complicated by CVD.
Collapse
Affiliation(s)
- Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Ise Red Cross Hospital, Mie, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Jun Yoshimatsu
- Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiko Sekizawa
- 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
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| |
Collapse
|
24
|
Inoue M, Tsuchihashi T, Hasuo Y, Ogawa M, Tominaga M, Arakawa K, Oishi E, Sakata S, Ohtsubo T, Matsumura K, Kitazono T. Salt Intake, Home Blood Pressure, and Perinatal Outcome in Pregnant Women. Circ J 2016; 80:2165-72. [DOI: 10.1253/circj.cj-16-0405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Minako Inoue
- Clinical Research Institute, National Hospital Organization Kyushu Medical Center
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takuya Tsuchihashi
- Clinical Research Institute, National Hospital Organization Kyushu Medical Center
- Steel Memorial Yawata Hospital
| | - Yasuyuki Hasuo
- Division of Obstetrics and Gynecology, National Hospital Organization Kyushu Medical Center
| | - Masanobu Ogawa
- Division of Obstetrics and Gynecology, National Hospital Organization Kyushu Medical Center
| | - Mitsuhiro Tominaga
- Division of Hypertension, National Hospital Organization Kyushu Medical Center
| | - Kimika Arakawa
- Division of Clinical Laboratory, National Hospital Organization Kyushu Medical Center
| | - Emi Oishi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Satoko Sakata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Toshio Ohtsubo
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Kiyoshi Matsumura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
25
|
Tanaka K, Tanaka H, Kamiya C, Katsuragi S, Sawada M, Tsuritani M, Yoshida M, Iwanaga N, Yoshimatsu J, Ikeda T. Beta-Blockers and Fetal Growth Restriction in Pregnant Women With Cardiovascular Disease. Circ J 2016; 80:2221-6. [DOI: 10.1253/circj.cj-15-0617] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kayo Tanaka
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University
| | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Shinji Katsuragi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Masami Sawada
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Mitsuhiro Tsuritani
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Masashi Yoshida
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Naoko Iwanaga
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University
| |
Collapse
|
26
|
Lu CW, Shih JC, Chen SY, Chiu HH, Wang JK, Chen CA, Chiu SN, Lin MT, Lee CN, Wu MH. Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease. Circ J 2015; 79:1609-17. [DOI: 10.1253/circj.cj-14-1368] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital
- Adult Congenital Heart Center, National Taiwan University Hospital
| | - Jin-Chung Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital
| | - Ssu-Yuan Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital
| | - Hsin-Hui Chiu
- Department of Pediatrics, National Taiwan University Hospital
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital
- Adult Congenital Heart Center, National Taiwan University Hospital
| |
Collapse
|
27
|
Hasegawa J, Ikeda T, Sekizawa A, Tanaka H, Nakata M, Murakoshi T, Katsuragi S, Osato K, Ishiwata I, Kinoshita K. Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension. Circ J 2015; 79:1835-40. [DOI: 10.1253/circj.cj-15-0297] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University School of Medicine
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, Sakakibara Heart Institute
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie University School of Medicine
| | | | | | | |
Collapse
|
28
|
|
29
|
Fujiwara K, Aoki S, Kurasawa K, Okuda M, Takahashi T, Hirahara F. Warfarin-associated fetal intracranial subdural hematoma: a case report. Clin Case Rep 2014; 2:108-11. [PMID: 25356261 PMCID: PMC4184605 DOI: 10.1002/ccr3.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/04/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022] Open
Abstract
Key Clinical Message We present a case in which to of fetal subdural hematoma developing despite that the maternal the prothrombin time by international normalized ratio (PT/INR) during pregnancy was within the normal range.
Collapse
Affiliation(s)
- Kana Fujiwara
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center Yokohama, Japan
| | - Kentaro Kurasawa
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center Yokohama, Japan
| | - Mika Okuda
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center Yokohama, Japan
| | - Tsuneo Takahashi
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University Hospital Yokohama, Japan
| |
Collapse
|
30
|
Higa T, Okura H, Tanemoto K, Yoshida K. Prosthetic valve thrombosis caused by heparin-induced thrombocytopenia thrombosis during pregnancy. Circ J 2013; 78:1004-5. [PMID: 24334636 DOI: 10.1253/circj.cj-13-0919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
31
|
Affiliation(s)
- Kazunori TOYODA
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| |
Collapse
|