Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

Hartopo, Anggoro Budi; Anggrahini, Dyah Wulan; Nurdiati, Detty Siti; Emoto, Noriaki; Dinarti, Lucia Kris

doi:10.1177/2045894019884516

Cited by 18 publications

(13 citation statements)

References 16 publications

(37 reference statements)

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“…Most CHD-related PAH patients (with uncorrected ASD) in Indonesia belonged to the intermediate-risk group, according to the 6MWT results [ 7 19 ]. In Indonesia, pregnant women with PH related to uncorrected CHD have a high risk of maternal mortality (12.5%), which was higher than the previous study by Hartopo et al (10.7%) [ 20 ]. This study indicated that 64.3% patients were diagnosed with CHD at the time of pregnancy [ 20 ].…”

Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 64%

“…In Indonesia, pregnant women with PH related to uncorrected CHD have a high risk of maternal mortality (12.5%), which was higher than the previous study by Hartopo et al (10.7%) [ 20 ]. This study indicated that 64.3% patients were diagnosed with CHD at the time of pregnancy [ 20 ]. It was observed during the study that no antenatal care for CHD condition was done to the patients [ 20 ].…”

Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 64%

“…This study indicated that 64.3% patients were diagnosed with CHD at the time of pregnancy [ 20 ]. It was observed during the study that no antenatal care for CHD condition was done to the patients [ 20 ]. Additionally, most pregnant patients who presented to the hospital were already in their third trimester of pregnancy.…”

Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 99%

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Pulmonary Arterial Hypertension in Indonesia: Current Status and Local Application of International Guidelines

et al. 2021

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Recent advances in the diagnosis and management of pulmonary arterial hypertension (PAH) have led to a significant improvement in the outcomes for patients with PAH. However, prompt and accurate diagnosis of PAH remains an unmet challenge due to lack of awareness and lack of meticulous data to profile the etiology and pathophysiology of this rare progressive disease, especially in low- and middle-income country. In Indonesia, the true prevalence and incidence of different subtypes of PAH in general population is still unknown. The Congenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry was the first single-center prospective registry in Indonesia, which indicated that almost 80% of adult patients with congenital heart disease (CHD) had experienced PAH and even Eisenmenger syndrome due to delayed diagnosis. Screening for early detection of asymptomatic CHD in children is yet to be systematically established in Indonesia, leading to undiagnosed and uncorrected CHD in adulthood. There are no specific national guidelines focusing on diagnostic workup and treatment of PAH in Indonesia. Furthermore, the lack of adequate diagnostic facilities, limited treatment availability, and limited drug coverage under the National Health Insurance Scheme are key issues that remain unaddressed. This review focuses on the diagnosis, treatment, and management of PAH associated with CHD in Indonesia as per international guidelines. We have proposed recommendations to effectively control and prevent PAH associated with CHD in Indonesia. The paper should be of interest to readers in the area of medical management and policy makers especially in low- and middle-income countries. Key Highlights: Pulmonary arterial hypertension (PAH) is a rare progressive subtype of pulmonary hypertension with poor overall prognosis and outcomes. Prompt and accurate diagnosis of PAH remains an unmet challenge in low- and middle-income countries due to poor knowledge about the etiology and pathophysiology of this syndrome. Also, the symptoms and signs of early-stage PAH are usually nonspecific or undetectable in newborn and infants, thus presenting a challenge for physicians to establish early diagnoses of PAH. The challenging factors in low- and middle-income countries, especially Indonesia archipelago are limitations of healthcare infrastructure, limited expertise, lack of awareness, lack of timely PAH screening strategies, poor antenatal care and unpredictable availability of PAH medications. There are no specific national guidelines focusing on diagnostic workup and treatment of PAH in Indonesia. Under-utilization of treatment guidelines and lack of adequate diagnostic treatment facilities have resulted in sub-optimal management of PAH patients in Indonesia. Adherence to international guidelines is an important aspect of PAH management in Indonesia. Updated disease and functional classifications of PAH as per internati...

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Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 64%

Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 64%

Section: Diagnosis Of Pah In Indonesia and Guideline Implementationmentioning

confidence: 99%

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Pulmonary Arterial Hypertension in Indonesia: Current Status and Local Application of International Guidelines

et al. 2021

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“…Due to the high risk of pregnant patients with PAH, clinical practice has been promoting contraception knowledge of PAH women, while improving PAH treatment methods [ 19 ]. Since 1990, some progress has been made in the treatment of PAH in China, and the mortality rate of patients with mild PAH has currently decreased to less than 10%, but the prognosis of patients with severe PAH remains unsatisfactory [ 20 ]. Although studies have shown that medication from early pregnancy can optimize the microcirculation of patients, drugs such as endothelin antagonists leave adverse effects on mothers and fetuses and cannot effectively improve maternal and fetal outcomes [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Han

Gao

Sun

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the effect of Yiqi Buxue decoction on hemodynamic changes of the uterine artery and fetal umbilical artery and pregnancy outcomes in pregnant patients with pulmonary arterial hypertension (PAH). Methods. 120 pregnant patients with PAH treated in our hospital (January 2019-January 2020) were chosen as the research objects, and randomly split into group A (n = 60) and group B (n = 60). Both groups received routine treatment, and group B was treated with sildenafil citrate, while group A was treated with Yiqi Buxue decoction combined with sildenafil citrate. Both groups received 6 weeks of treatment to analyze the hemodynamic changes of the uterine artery and fetal umbilical artery and compare the cardiopulmonary function indexes and pregnancy outcomes between the two groups. Results. The hemodynamic indexes of the uterine artery and fetal umbilical artery, cardiopulmonary function indexes, and pregnancy outcomes in group A after treatment were notably better compared with group B ( P < 0.01 ). Conclusion. Yiqi Buxue decoction can stabilize the hemodynamics of pregnant patients with PAH, improve their cardiopulmonary function, alleviate hypotension, and thus, reduce the possibility of adverse pregnancy outcomes, which should be popularized in practice.

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“…Pregnant patients with uncorrected heart disease increased maternal mortality by 10.7%, and those with heart disease and pulmonary edema increased maternal mortality by 12.5%. The worsening outcome in pregnancy and childbirth of pregnant patients with heart disease and pulmonary edema is largely caused by a compromised cardiovascular system and worsening breathing (Hartopo et al, 2019).…”

Section: Path Analysismentioning

confidence: 99%

Maternal Mortality in Klaten Regency (Determinant Factors Analysis)

Sesunan

Respati

Sulistyowati

2021

J MATERN CHILD HEALTH

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Background: Failure in reducing maternal mortality has become one of the world's health problems. Indonesia ranks third on the list of the highest MMR in ASEAN countries. The incidence of maternal mortality is caused by several factors, including reproductive status, obstetric complications, health services, and socioeconomic conditions. Subjects and Method:This study was an analytic observational study using a case-controlled study design. The study subjects were selected by using fixed random sampling with a total sample of 129 people consisting of 43 cases of maternal mortality in Klaten Regency and 86 controls. Maternal mortality data were taken in Klaten Regency from 2017 to 2019. The independent variables were pregnancy complications, delivery complications, postpartum complications, age of pregnant women, pregnancy spacing, parity, delay in making decisions, referral delay due to inadequate transportations, delay in handling by health workers, the quantity of ANC, maternal education, maternal occupation, and family income. The dependent variable was maternal mortality in Klaten Regency. The data collection of this study used a questionnaire. Data analysis was carried out by univariate, bivariate, and multivariate methods using the chi-square test. Path analysis and descriptive analysis were performed and presented in narrative form. Results:The delay in making decisions increases with family income below the city minimum wage (OR = 1.69; p = 0.09). Referral delay increases with family income below the minimum wage (OR = 1.73; p = 0.08). Maternal mortality increased with delay in decision making (OR = 5.-28; p = 0.00), quantity of ANC (OR: 2.37; p: 0.-02), income (OR: 3.92; p: 0.00), delivery complications (OR: 2.71; p: 0.01) ), postpartum complications (OR: 6.33; p: 0.00). Maternal mortality was indirectly affected by income. Conclusion: Pregnancy complications, delivery complications, postpartum complications, ANC examinations, delay in making decisions, delay in reaching the referral place, maternal education and income are associated with an increased risk of maternal mortality. While, maternal age, parity, pregnancy spacing, delay in handling by health workers, and maternal occupation have no significant association with maternal mortality.

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Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

Cited by 18 publications

References 16 publications

Pulmonary Arterial Hypertension in Indonesia: Current Status and Local Application of International Guidelines

Pulmonary Arterial Hypertension in Indonesia: Current Status and Local Application of International Guidelines

Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Maternal Mortality in Klaten Regency (Determinant Factors Analysis)

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