Congenital heart disease in pregnancy: Short- and long-term implications

Shime, J.; Mocarski, Eva; Hastings, D. R.; Webb, Gary D.; McLaughlin, Peter R.

doi:10.1016/0002-9378(87)90275-4

Cited by 182 publications

(88 citation statements)

References 13 publications

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“…3,4 In the present study we found a low rate of cardiac events during pregnancy, which is in agreement with the small amount of existing literature. [5][6][7][8] The risk of obstetric events was associated with the corrective status. The presence of an unrepaired VSD was associated with a higher risk of pre-eclampsia (8.7%).…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Despite the fact that a VSD is one of the most common forms of heart disease among pregnant women, VSD-specific pregnancy data are limited. [5][6][7][8] A recent literature review of studies published between 1985 and 2007 found a total of 83 completed pregnancies among women with VSDs (combining repaired and unrepaired VSD). 9 The current consensus is that pregnancy in women with an isolated VSD is generally well tolerated, with no maternal mortality and no significant maternal or fetal morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

Yap

Drenthen

Pieper

et al. 2010

BJOG

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

Yap

Drenthen

Pieper

et al. 2010

BJOG

View full text Add to dashboard Cite

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“…We contend that the multidisciplinary approach to our patients' management contributed considerably to the good outcome in all seven cases in which the team was involved. While the details of medical management changed over the ten years reported here, our patient care, from 1978 onwards, was essentially similar to that advocated by Shime et al in 1987. They used a multidisciplinary approach, with bed rest, prenatal oxygen, frequent prenatal assessments, and favoured vaginal delivery with well-controlled epidural analgesia.…”

Section: Team Managementmentioning

confidence: 74%

Pulmonary hypertension and pregnancy: a series of eight cases

1994

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“…MI risk is higher in multiparas and augments with age (8.8, 19.0 and 30.2 over 100,000 births respectively for women of [30][31][32][33][34][35][36][37][38][39], over 40 years old.…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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Congenital heart disease in pregnancy: Short- and long-term implications

Cited by 182 publications

References 13 publications

Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

Pulmonary hypertension and pregnancy: a series of eight cases

Pregnancy and heart disease: what Internists should know

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