Cardiac complications during pregnancy are better predicted with the modified WHO risk score

Pijuan‐Domenech, Antònia; Galian, L; Goya, María; Casellas, M.; Merced, Carme; Ferreira‐González, Ignacio; Mora, J.R. Marsal; Dos‐Subirà, Laura; Subirana-Domènech, Maria Teresa; Pedrosa, Valle; Baró-Mariné, Francesc; Manrique, Susana; Casaldàliga-Ferrer, Jaume; Tornos, Pilar; Cabero, L.; Garcı́a-Dorado, David

doi:10.1016/j.ijcard.2015.05.076

Cited by 71 publications

(47 citation statements)

References 25 publications

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“…15 Studies having preponderance of congenital heart disease subjects show more accuracy of WHO classification for prediction of adverse maternal outcome as the study done by Domenech P et al had 68% CHD but only 16% valvopathies. 16 Another alarming observation was the total lack of pre-pregnancy counseling in all of the study population despite living in capital of India. Prepregnancy counseling and adequate risk assessment during pregnancy are essential components in management of this high-risk pregnancy.…”

Section: Discussionmentioning

confidence: 96%

Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

Sharma¹,

Malik²,

Pandit³

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the predominant heart disease is still RHD (rheumatic heart disease), whereas in the developed countries congenital heart disease is more common.Methods: This prospective observational study conducted in Department of Obstetrics and Gynecology in carried in PGIMER and Dr. RML Hospital, New Delhi from November 2015 to March 2017. 35 patients with heart disease were included in this study eight risk factors, four non-cardiac (age, parity, BMI and time of reporting to hospital) and four cardiac risk factors (etiology of lesion, type of lesion, prosthetic valve on anticoagulation and associated cardiac complication like atrial fibrillation (AF), pulmonary edema, pulmonary artery hypertension (PAH) were co-related with predefined indicators for adverse feto-maternal outcome. NYHA class, CARPREG score, modified WHO class were also co-related with adverse feto-maternal outcome.Results: RHD is still more common than CHD in our population. No association was seen between any non-cardiac risk factor and adverse maternal outcome. Among cardiac risk factors, severe MS, severe PAH, NYHA class IV, AF, CARPREG score ≥2 were significantly associated with adverse maternal and fetal outcome. There was no maternal or fetal death in the present study.Conclusions: Severe MS, severe PAH, AF, NYHA Class IV, CARPREG score ≥2 had positive predictive value for adverse feto maternal outcome in the present study which had no maternal or fetal mortality. Need for Preconceptional counselling which was seen to be totally absent in the present study is emphasized.

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Section: Discussionmentioning

confidence: 96%

Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

Sharma¹,

Malik²,

Pandit³

2018

Int J Reprod Contracept Obstet Gynecol

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“…The WHO classification is a valuable tool for this purpose, and FTs should not be performed in women fulfilling WHO class III and IV critieria. 7,[15][16][17] With regards to the increased thromboembolic risk during or after ART usage, it is important to identify highrisk women for whom thromboembolic prophylaxis with stockings and heparin should be considered, particularly if OHSS occurs. 49,50 …”

Section: Discussionmentioning

confidence: 99%

“…7 Of these, the modified World Health Organization (WHO) classification appears to be the most reliable score for the prediction of maternal risk. 7,[15][16][17] As shown in Table 1, conditions in which pregnancy risk is significantly elevated are summarized in WHO class III, and contraindications for pregnancy are summarized in WHO class IV. As a matter of fact, FTs should not be performed under these conditions.…”

Section: Risk Stratification and Counsellingmentioning

confidence: 99%

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

Rossberg

Stangl

2016

Eur J Prev Cardiolog

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A growing number of women with heart disease are considering pregnancy with the help of assisted reproductive technology (ART). Although an ever-increasing amount of knowledge exists on pregnancy in both congenital and acquired heart disease patients, little information is available on fertility treatments specifically in these women. This review seeks to provide an overview of the existing data and explores areas in need of research in this field. Changes in the hormonal environment seen in ART patients initially entail an increase then a decrease in blood pressure and peripheral vascular resistance. A shift in the thrombotic-thrombolytic balance towards coagulation is observed. Compared to normal pregnancy, ART-conceived pregnancies exhibit an increased adverse event rate for both the mother and foetus, including a higher incidence of hypertensive disorders and an increase in thromboembolic events during the first trimester. Ovarian hyperstimulation syndrome in particular can cause dramatic haemodynamic changes and an increase in upper body thrombosis. Viewing these findings within the context of women with an underlying heart disease reveals indications that maternal and neonatal complications after fertility treatments are higher. Pre-pregnancy risk assessment is essential to identifying women with heart disease for whom ART may be dangerous and therefore inappropriate.

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“…Both CARPREG and ZAHARA models overestimated adverse outcomes, and the modified WHO model had the best predictive power [9]. Additional studies have confirmed the superiority of the modified WHO model [10,11].…”

Section: Maternal Outcomesmentioning

confidence: 97%

Hemodynamically Significant Congenital Cardiac Lesions in Pregnancy

Prabhu

Bryant

2016

Curr Treat Options Cardio Med

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The incidence of congenital cardiac disease among reproductive-aged women is increasing. Understanding the unique physiology of pregnancy and the postpartum period is critical to helping women achieve successful pregnancy outcomes. Risk assessment models estimate the cardiac, obstetric, and neonatal risks a woman may face and influence the conversations regarding pregnancy and contraception management. This review focuses on some of the most common congenital cardiac lesion encountered during pregnancy, as well as key aspects of antepartum, intrapartum, and postpartum care for these women. A multidisciplinary team, with Maternal-Fetal Medicine, Cardiology and Obstetric Anesthesiology specialists, is critical to the care of these patients.

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Cardiac complications during pregnancy are better predicted with the modified WHO risk score

Cited by 71 publications

References 25 publications

Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

Pregnancy and cardiovascular risk: A review focused on women with heart disease undergoing fertility treatment

Hemodynamically Significant Congenital Cardiac Lesions in Pregnancy

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