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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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Avila WS, Ribeiro VM, Rossi EG, Binotto MA, Bortolotto MR, Testa C, Francisco R, Hajjar LA, Miura N. Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge. Arq Bras Cardiol 2019; 113:1062-1069. [PMID: 31596322 PMCID: PMC7021269 DOI: 10.5935/abc.20190197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/15/2019] [Accepted: 03/10/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. OBJECTIVES To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. METHODS During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. RESULTS Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. CONCLUSIONS Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.
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Affiliation(s)
- Walkiria Samuel Avila
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Veronica Martins Ribeiro
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Eduardo Giusti Rossi
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Maria Angelica Binotto
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Maria Rita Bortolotto
- Clinica Obstétrica do Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Carolina Testa
- Clinica Obstétrica do Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Rossana Francisco
- Clinica Obstétrica do Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Ludhmilla Abraão Hajjar
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Nana Miura
- Instituto de Coração do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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Henriquez DD, Roos-Hesselink JW, Schalij MJ, Klautz RJ, Helmerhorst FM, de Groot CJ. Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome. Cochrane Database Syst Rev 2011:CD008128. [PMID: 21563164 DOI: 10.1002/14651858.cd008128.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear. OBJECTIVES To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy. DATA COLLECTION AND ANALYSIS We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy. MAIN RESULTS There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy. AUTHORS' CONCLUSIONS There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.
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Affiliation(s)
- Dacia Dca Henriquez
- Department of Gynaecology, Medical Centre Haaglanden, Lijnbaan 32, The Hague, Netherlands
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Yap SC, Drenthen W, Pieper PG, Moons P, Mulder BJM, Vliegen HW, van Dijk APJ, Meijboom FJ, Jaddoe VWV, Steegers EAP, Boersma E, Roos-Hesselink JW. Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect. BJOG 2010; 117:683-9. [PMID: 20156207 DOI: 10.1111/j.1471-0528.2010.02512.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the risks of pregnancy complications in women with repaired and unrepaired isolated ventricular septal defect (VSD). DESIGN A retrospective multicentre study. SETTING Tertiary centres in the Netherlands and Belgium. METHODS Women were identified using two congenital heart disease registries. Eighty-eight women were identified who had experienced 202 pregnancies, including 46 miscarriages and nine terminations of pregnancy. Information on each completed pregnancy (n = 147; unrepaired VSD, n = 104; repaired VSD, n = 43) was obtained using medical records and telephone interviews. Data from the Generation R database (prospective cohort study; n = 9667) were used to determine the background risk (controls). Odds ratios and 95% CI were estimated using general estimation equation analysis adjusted for multiple pregnancies per woman, maternal age and parity status. MAIN OUTCOME MEASURES Adjusted odds ratios (AORs) for developing pregnancy complications in relation to corrective status. RESULTS Pregnancies in women with an unrepaired VSD were associated with a higher risk of pre-eclampsia (AOR 4.59, 95% CI 2.01-10.5, P < 0.001) compared with controls. No differences were observed when comparing women with repaired VSD and controls. Pregnancies in women with repaired VSD were associated with a higher risk of premature labour (AOR 4.02, 95% CI 1.12-14.4, P = 0.03) and small-for-gestational-age (SGA) births (AOR 4.09, 95% CI 1.27-13.2, P = 0.02) compared with women with unrepaired VSD. CONCLUSIONS Women with unrepaired VSD are at increased risk of pre-eclampsia, which suggests that it is not a benign condition. In addition, women with repaired VSD are at increased risk of premature labour and SGA births compared with women with unrepaired VSD.
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Affiliation(s)
- S-C Yap
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
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Effect of pulmonary stenosis on pregnancy outcomes--a case-control study. Am Heart J 2007; 154:852-4. [PMID: 17967589 DOI: 10.1016/j.ahj.2007.07.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 07/30/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pulmonary stenosis (PS) accounts for 10% to 12% of congenital heart disease in adults, and the probability of survival to child bearing age is high. The impact of PS on pregnancy has not been extensively studied in the recent era. METHODS We evaluate the effect of isolated PS on maternal and fetal outcomes in a case-control study of 17 cases with PS in pregnancy from 1995 to 2006. The control group was matched by age, ethnicity, obstetrical history, and year of delivery. Patients with PS were assessed for maternal New York Heart Association (NYHA) functional class and other maternal complications at baseline and during pregnancy; and the 2 groups were compared for fetal and neonatal outcomes including birth weight, gestational age at delivery, Apgar scores, and placental weight. RESULTS A total of 11 patients were in NYHA functional class I and 6 in class II at the time of presentation. All patients remained stable during pregnancy except for two. One of them deteriorated from NYHA functional class I to II, and the other from class II transiently to class III. There were no other maternal complications. In addition, there were no statistically significant differences in fetal/neonatal outcomes between patients and their controls and between patients with mild and severe PS. CONCLUSIONS In contrast to mitral and aortic stenosis, PS does not adversely impact maternal or fetal outcomes of pregnancy.
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Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJM, van Dijk APJ, Vliegen HW, Yap SC, Moons P, Ebels T, van Veldhuisen DJ. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49:2303-11. [PMID: 17572244 DOI: 10.1016/j.jacc.2007.03.027] [Citation(s) in RCA: 349] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/27/2007] [Accepted: 03/13/2007] [Indexed: 01/18/2023]
Abstract
A search of peer-reviewed literature was conducted to identify reports that provide data on complications associated with pregnancy in women with structural congenital heart disease (CHD). This review describes the outcome of 2,491 pregnancies, including 377 miscarriages (15%) and 114 elective abortions (5%). Important cardiac complications were seen in 11% of the pregnancies. Obstetric complications do not appear to be more prevalent. In complex CHD, premature delivery rates are high, and more children are small for gestational age. The offspring mortality was high throughout the spectrum and was related to the relatively high rate of premature delivery and recurrence of CHD.
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Affiliation(s)
- Willem Drenthen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
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