Pregnancy in women after coronary revascularization

Quiñones, Joanne N.; Cox, David A.; Smolinski, William J; Maksimik, Crystal; Coassolo, Kara M.; Freudenberger, Ronald S

doi:10.1177/1753495x14546434

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…[3][4][5] The incidence of preeclampsia and fetal growth restriction were increased in these cases. [2][3][4][5][6] Recurrent MI was not reported prenatally; however, there was a case of postpartum heart failure. 2 In our case, recurrent MI occurred 3 weeks postpartum despite LMWH, aspirin, and statins, with evidence of dissection in the ectatic coronary vessels.…”

Section: Discussionmentioning

confidence: 89%

“…The majority of reported cases of previous MI in pregnancy have been treated with stenting or coronary artery bypass graft before conception 3–5 . The incidence of preeclampsia and fetal growth restriction were increased in these cases 2–6 . Recurrent MI was not reported prenatally; however, there was a case of postpartum heart failure 2 .…”

Section: Discussionmentioning

confidence: 99%

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Managing pregnancy after myocardial infarction and ectatic coronary vessels

Ramly

Mahamooth

Abidin

et al. 2022

Intl J Gynecology & Obste

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Thyroid disease is the second most common cause of endocrinopathy in pregnant women, affecting approximately 3%. 1 Maternal thyroid dysfunction (mainly overt hypothyroidism) can influence maternalfetal health and cause obstetric complications. 2 However, whether or not to perform universal screening for thyroid dysfunction remains controversial, with no consensus between clinical practice guidelines. 3 The primary aim of our study was to evaluate the impact of universal screening implantation on adverse pregnancy outcomes in the setting of real-world clinical practice. A secondary

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Managing pregnancy after myocardial infarction and ectatic coronary vessels

Ramly

Mahamooth

Abidin

et al. 2022

Intl J Gynecology & Obste

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“…Although women of child bearing age are considered to comprise a generally healthy population, 0.4-4.5% of pregnant women in developed countries are diagnosed with cardiovascular disease [3] . Pregnancy, in of itself is an independent risk factor for the development of antenatal myocardial infarction with a fourfold increase risk compared to non-pregnant women [4] ; this is becoming of increasing prevalence as women are more frequently becoming pregnant at more advanced ages [4,5] . Eleven percent of maternal deaths that occur in the developed world are due to complications of cardiomyopathy [1] .…”

Section: Discussionmentioning

confidence: 99%

“…Adequate control of the underlying cardiac disease in addition to other comorbidities helps to prevent complications associated with the normal physiologic and hemodynamic changes that occur with pregnancy [5,6] . Furthermore, invasive interventions, such as angioplasty may be indicated, and are favorable to the potentially unfavorable outcomes of emergent cardiac surgery or cardiopulmonary resuscitation during acute cardiac events [6,7] .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, PCI will confer protective effects on maternal well-being, particularly during a time of increased cardiac stress [4] . Occurrences of antenatal PCI with drug-eluting stents and dual anti-platelet therapy with successful subsequent deliveries have been well documented, although increased incidence of post-operative bleeding has been observed [5,8] . However, due to risk of re-thrombosis, some form of anticoagulation is usually continued through the peripartum period, and the risks and benefits are each patient are weighed on an individual basis depending on the risk of re-occlusion and the risk of post-operative bleeding [8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

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The Anesthetic Management of a Pre-Term Parturient Undergoing Urgent Cesarean Delivery for Fetal Complications within 30 Days of Drug-Eluting Stent Placement: A Case Report and Literature Review

Anthony¹,

Gittens²,

Chaudhry³

et al. 2018

JAS

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Cardiomyopathy in pregnancy is a prevalent disease we encounter as obstetric anesthesiologists, and can be a major cause of maternal perinatal morbidity and mortality if not appropriately managed, particularly during the antepartum period [1]. The gold standard of care remains neuraxial anesthesia with adequate labor analgesia and vaginal delivery if feasible [2]. However, this technique is not always appropriate as women may present with contraindications to neuraxial anesthesia, such as women on anticoagulation. This is particularly noted in women who have known cardiac disease, as women who undergo coronary interventions prior to labor are managed with chemical anticoagulation. General anesthetic consideration for this population takes into account not only cardiac techniques but the implications on fetal wellbeing [2]. Although maternal outcomes remain our priority as the safety of the mother is necessary for fetal survival, improving fetal status at birth is ideal. In this particular paper, we discuss the challenges we faced in a parturient who underwent percutaneous coronary intervention during her pregnancy, and required urgent cesarean section within 30 days of receiving a drug-eluting stent. We present the literature surrounding these concerns and the options available to anesthesiologists to provide safe anesthesia for both mother and fetus. Objectives The purpose of this manuscript is to discuss the proper evaluation of the parturient with cardiac disease, to provide an overview of the literature, and to properly formulate a safe obstetric and labor plan in women with confirmed cardiomyopathy.

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