Maternal Cardiac Output and Fetal Doppler Predict Adverse Neonatal Outcomes in Pregnant Women With Heart Disease

Abstract

BackgroundThe mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated.Methods and ResultsPregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small‐for‐gestational‐age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome. One hundred and twenty‐seven women with cardiac disease and 45 healthy controls were enrolled. Neonatal events occurred in 28 pregnancies and were more frequent in the heart disease group as compared with controls (n=26/127 or 21% versus n=2/45 or 4%; P=0.01). Multiple complications in an infant were counted as a single outcome event. Neonatal complications in the heart disease group were small‐for‐gestational‐age/low birthweight (n=18), prematurity (n=14), and intraventricular hemorrhage/respiratory distress syndrome (n=5). Preexisting obstetric risk factors (P=0.003), maternal cardiac output decline from baseline to third trimester (P=0.017), and third trimester umbilical artery Doppler abnormalities (P<0.001) independently predicted neonatal complications and were incorporated into a novel risk index in which 0, 1, and >1 predictor corresponded to expected complication rates of 5%, 30%, and 76%, respectively.ConclusionsDecline in maternal cardiac output during pregnancy and abnormal umbilical artery Doppler flows independently predict neonatal complications. These findings will enhance the identification of higher risk pregnancies that would benefit from close antenatal surveillance.

Third trimester Doppler ultrasound as prediction of obstetric outcome in high-risk pregnancy, Gujarat, India

“…Mean maternal age in present study was 26.8 years and these findings are consistent with the similar study done by wald RM et al, Garcia et al and Rai L et al [11][12][13] Study included similar number of participants of primigravida and multigravida. Caesarean section was reportedly less in number in comparison with vaginal delivery and fetal distress eas the main indication for caesarean section.…”

“…Caesarean section was reportedly less in number in comparison with vaginal delivery and fetal distress eas the main indication for caesarean section. These findings are comparable with the findings of study done by Rai L et al and Garcia B et al 12,13 Mean birth weight in present study was 2150 gm but these findings are not comparable with similar study done by Wald RM et al, Garcia B at al, Peixoto et al and Li H et al 6,11,12,14 Oligohydramnios, SFGR, Pre-eclamsia, Anemia are the most common pregnancy complications respectively.…”

“…15 This is in contrast to the findings of Ghosh et al where RI and PI were considered better indicators of vascular impedance in predicting adverse perinatal outcomes. 16 B/L notch in uterine artery Doppler was present in 25.4% participants and this findings are quit comparable with the similar study done by Wald RM et al, Rai L et al but not consistent with study done by Maria AL et al and Li H et al 11,13,14,17 Study found acceptable sensitivity, specificity, PPV and NPV of Doppler ultrasound during third trimester to predict obstetrical and perinatal outcome and this findings are comparable with study done by Rai L et al 13 Limitations of this study was number of cases has been small and study not included Patients who came in labor or with a complication like abruptio placenta.…”

Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot

“…In addition, Wald et al . recently found the decline in cardiac output during pregnancy in women with heart disease to be independently predictive for neonatal complications. There is also evidence that in previously healthy women with high uteroplacental resistance and poor pregnancy outcome there is an increased prevalence of systolic and diastolic left ventricular dysfunction.…”

“…Wald et al . found a decline in cardiac output during pregnancy in women with heart disease predictive for neonatal complications. This might suggest that cardiac reserve in women with heart disease is not sufficient to meet the increased demand of the growing fetus and the near‐term placenta, leading to adverse neonatal outcome.…”