The management of labour in women with cardiac disease: need for more evidence?

Cauldwell, Matthew; Cox, Mark; Nelson‐Piercy, Catherine; O’Brien, Pat; Roos-Hesselink, J.W.; Thorne, Sara; Walker, Fiona; Johnson, _______

doi:10.1111/1471-0528.14547

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…[16] [17]. In this study, cesarean delivery represented 48.9% of cases, with non-obstetrical indications representing 31.8% thereof, and vaginal delivery 51.1%, none of which was instrumental.…”

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confidence: 62%

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals

Ngowa¹,

Kengne²,

Nsahlai³

et al. 2022

OJOG

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Heart disease in pregnancy is the cause of significant maternal and perinatal morbidity. We wanted to evaluate the maternal and perinatal outcomes of pregnant women with heart disease in Yaoundé, Cameroon. This was a cross sectional study with retrospective data collection of 45 pregnancies in 42 women with heart disease followed at three Yaoundé referral hospitals in Yaoundé, Cameroon from January 1 st 2015 to December 31 st 2020. We collected data on maternal obstetrical and perinatal outcomes. The frequency of pregnancies with heart diseases was 0.1%. The mean maternal age was 29.05 ± 6.5 years. At first antenatal visit, all patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class. Valvular heart disease (51.1%) was the most common type followed by cardiomyopathy (37.7%). Over half of the deliveries were vaginal (51.1%). A cesarean section was generally indicated for the usual obstetrical reasons (54.5%) and for heart disease (31.8%). Complications included 17 (37.7%) cases of heart failure, 6 (13.3%) cases of pulmonary edema, 2 (04.4%) cases of pulmonary embolism, 3 (06.6%) maternal deaths and 3 (06.3%) perinatal deaths, 14 (29.7%) premature births and 3 cases of (6.3%) intrauterine growth retardation. The maternal deaths were cases complicated by pulmonary edema and all had dilated cardiomyopathy. The maternal and perinatal outcomes of pregnant women with heart disease are marked in our environment by increased morbidity and mortality. Therefore, it is necessary to improve the prenatal, per partum and postpartum management of this high-risk group.

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confidence: 62%

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals

Ngowa¹,

Kengne²,

Nsahlai³

et al. 2022

OJOG

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“…These included gestational hypertension (GH), preeclampsia (PET), antepartum and post-partum haemorrhage, placental dysfunction, i.e., placenta praevia and accreta, threatened premature onset of labour, preterm birth, failure to progress in labour, intrauterine growth restriction (IUGR) and maternal sepsis [4,16]. Also, the guidelines recommend vaginal delivery for women with cardiac conditions, with a shortened active phase in the second stage of labour to mitigate cardiovascular stress and potential complications; therefore, data on delivery methods were collected [34].…”

Section: Clinical Outcome Variablesmentioning

confidence: 99%

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

et al. 2021

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Background/Aims Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications. Methods Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories’ clinical outcomes. Results This maternal cohort’s (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care. Conclusions Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score. Trial registration ACTRN12617000417381.

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“…Passive descent of the fetal head at full dilatation should also be employed as this has been shown to reduce the duration of maternal pushing 38. Limiting maternal pushing with an earlier assisted delivery has been proposed for some women with cardiac disease although the benefits of this for women with heart disease in general and IHD specifically remain unclear 39. Active management of the third stage (early cord clamping and administration of uterotonic agent) is usually recommended for women with heart disease as it reduces the risk of postpartum haemorrhage by 40% 40.…”

Section: Management Of Labour and Deliverymentioning

confidence: 99%

Ischaemic heart disease and pregnancy

Cauldwell

Baris

Roos‐Hesselink

et al. 2018

Heart

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Although ischaemic heart disease is currently rarely encountered in pregnancy, occurring between 2.8 and 6.2 per 100 000 deliveries, it is becoming more common as women delay becoming pregnant until later life, when medical comorbidities are more common, and because of the higher prevalence of obesity in the pregnant population. In addition, chronic inflammatory diseases, which are more common in women, may contribute to greater rates of acute myocardial infarction (AMI). Pregnancy itself seems to be a risk factor for AMI, although the exact mechanisms are not clear. AMI in pregnancy should be investigated in the same manner as in the non-pregnant population, not allowing for delays, with investigations being conducted as they would outside of pregnancy. Maternal morbidity following AMI is high as a result of increased rates of heart failure, arrhythmia and cardiogenic shock. Delivery in women with history of AMI should be typically guided by obstetric indications not cardiac ones.

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The management of labour in women with cardiac disease: need for more evidence?

Cited by 7 publications

References 18 publications

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

Ischaemic heart disease and pregnancy

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The management of labour in women with cardiac disease: need for more evidence?

Cited by 7 publications

References 18 publications

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaound&#233; Referral Hospitals

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaound&#233; Referral Hospitals

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

Ischaemic heart disease and pregnancy

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Product

Resources

About

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaoundé Referral Hospitals