Expert consensus document on management of cardiovascular diseases during pregnancy The Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology

Oakley, Celia M.; Child, Anne H.; Jung, Bernard; Presbitero, P; Tornos, Pilar; Klein, W.; García, María Ángeles Alonso; Blomström‐Lundqvist, Carina; Dargie, Henry J.; Deckers, Jaap W.; Flather, Marcus; Hradec, J; Mazzotta, Gianfranco; Oto, Ali̇; Parkhomenko, Alexander; Silber, Sigmund; Torbicki, Adam; Trappe, Hans‐Joachim; Dean, Veronica; Poumeyrol-Jumeau, Dominique

doi:10.1016/s0195-668x(03)00098-8

Cited by 315 publications

(25 citation statements)

References 114 publications

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“…Cesarean section allows better hemodynamic stability compared to vaginal delivery and, although the cardiac output increases during both general and epidural anesthesia, the increase is less than during spontaneous delivery [7]. In fact, during labor, cardiac output increases by approximately 10% in the early first stage and up to 40% in the second stage compared to measurements before labor.…”

Section: Discussionmentioning

confidence: 99%

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Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Cozzolino

Perelli²,

Corioni³

et al. 2014

Gynecol Obstet Invest

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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic myocardial disorder characterized by the replacement of myocardium by fibro-adipose tissue. The proper obstetric management of this disease remains unclear due to the lack of an adequate number of cases reported in the literature. We report the successful management of a pregnant patient with ARVC. A female patient with ARVC presented to our hospital at 9 weeks of gestation. Before pregnancy, she was treated with bisoprolol, which resulted in a reduction in extrasystoles and she never developed palpitations. Periodical cardiological examinations showed clinical stability, and the only therapeutic change consisted of an increase in the bisoprolol dosage. She delivered at term by elective cesarean section. We decided that avoiding changes in the chronic therapy of our patient was the best management because she had reached clinical stability before pregnancy and discontinuation of therapy may pose an addition risk. In our opinion, cesarean section was the best mode of delivery in our ARVC patient to avoid the stress of labor, which may raise heart rate and cause arrhythmia. Our experience and the case reports in the literature suggest that pregnancy is tolerated in female patients with ARVC, but they need to be monitored during pregnancy by a multidisciplinary team.

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Section: Discussionmentioning

confidence: 99%

“…Labor and delivery also cause increases in cardiac output and blood pressure as well as oxygen consumption during uterine contractions. These hemodynamic modifications are influenced by the mode of delivery [7]. …”

Section: Introductionmentioning

confidence: 99%

Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Cozzolino

Perelli²,

Corioni³

et al. 2014

Gynecol Obstet Invest

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“…For these reasons, elective delivery by caesarean section just prior to cardiopulmonary bypass has been advocated to minimize maternal and foetal risks [8]. There are, however, no published studies in support of caesarean section or natural childbirth in women suffering from endocarditis, and even European guidelines provide no useful information on the matter [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Maternal mortality rate, however, is significant high (33%), most deaths being related to heart failure or an embolic event [3]; even the rate of foetal mortality can reach 29%. Infective endocarditis in pregnancy can present difficulties in management, such as the choice of appropriate antibiotic treatment and the choice of optimal time for delivery and cardiac surgery [4]. The case report we present here clearly illustrates these therapeutic dilemmas.…”

Section: Introductionmentioning

confidence: 86%

Infectious endocarditis during pregnancy, problems in the decision-making process: a case report

Vizzardi

Cicco

Zanini

et al. 2009

Cases J

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Infective endocarditis in pregnancy has a low incidence, often being associated with a previous history of rheumatic or congenital heart disease. In most reports the disease tends to run a subacute course and to appear more frequently in the third trimester of pregnancy. We present the case of a 36-year-old woman with large vegetations on the mitral valve due to infective endocarditis detected at the 32nd week of her first pregnancy. The difficulties in selecting the appropriate management strategy, particularly optimal time and mode of delivery, optimal time and type of valve surgery, are emphasized.

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“…Nevertheless, it suffices to mention here that the potential risk for pregnancy is probably largely related to pregnancy-induced increased cardiac output and hyper-dynamic circulation,[8] which will be poorly tolerated by the already stressed right ventricular (RV) in patients with PH, and is associated with an increased rate of morbidity and mortality for mother and baby as high as 50% in severe cases. [91011] Despite the fact that successful pregnancies have been reported in idiopathic pulmonary arterial hypertension (IPAH) patients,[12] it is strongly agreed between all experts in the field of pulmonary vascular diseases and clinical guidelines that pregnancy is to be avoided or terminated in women with advanced PH.…”

Section: General Measuresmentioning

confidence: 99%

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: General management for pulmonary hypertension

Idrees¹,

Swiston²,

Levy³

2014

Ann Thorac Med

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Treatment of pulmonary hypertension (PH) patients is challenging and should only be initiated after a comprehensive diagnostic evaluation. Such treatment should ideally be done in specialized centers with full capability for hemodynamic measurements, having access to a broad range of PAH therapies, and adequate experience in the management of critically ill patients.The following discussion is intended to review the general measures and the non-specific (supportive) therapy used in managing PH patients, while the specific therapy will be discussed in a subsequent different article.

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Expert consensus document on management of cardiovascular diseases during pregnancy The Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology

Cited by 315 publications

References 114 publications

Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Infectious endocarditis during pregnancy, problems in the decision-making process: a case report

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: General management for pulmonary hypertension

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