The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

Abstract

BackgroundTo evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity.Methods and FindingsSecondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively.ConclusionsIn this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity.

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

“…They were organized in two research groups. The first refers to two articles from the "Nascer no Brasil" ("Born in Brazil") study, 5,34 the second reports 13 articles from the Multicenter Study of the "Rede Nacional de Vigilância de Morbidade Materna Grave" [35][36][37][38][39][40][41][42][43][44][45][46][47] ('National Surveillance Network on Severe Maternal Morbidity"). All articles of national scope used the WHO criteria for near miss.…”

“…Cecatti et al 35 present overall results, and the other articles explore MNM according to age group 36 and with specific conditions: abortion, 37 ectopic pregnancy, 38 hypertensive diseases, 39,40 hemorrhage, 41,42 infections, 43,44 heart diseases. 45 Healthcare factors were also analyzed, such as quality of care 46 and the association with cesarean section 47 based on Robson's Classification.…”

Women with cardiopathy in the context of reproductive planning: contributions of phenomenological hermeneutics

“…In parallel, when assessing the impact of the heart disease during pregnancy, it was found that most complications that increase the maternal morbidity and mortality occur in women known to be heart disease bearers, reinforcing the importance of the Reproductive Planning. [3][4] Reproductive Planning is often confused with Family Planning and Preconception counseling. The later are tools that make up the former, which should start at the beginning of the sexual life, especially for women with heart disease.…”

“…1 Heart disease has been pointed as the main cause of indirect obstetric maternal death worldwide and, in Brazil, also associated with increased near miss events. [2][3] The medical diagnosis of heart disease occurs previously the pregnancy classified as high risk due to the increased chance of maternal and fetal complications. The presence of predictors such as cyanosis, functional class greater than II, ventricular ejection fraction less than 40% and previous cardiovascular disorders, increase the additional risk of heart events in the gestational period by 25% and 75% this same risk if identified two or more factors.…”

Cardiovascular emergencies and cardiac arrest in a pregnant woman

“…Maternal nearmiss occurred in 15% of cardiac patients compared to 7.7% in non-cardiac patients (p<0.001). Maternal death occurred in 4.8% and 1.2% of cardiac and non-cardiac patients respectively [11,12]. Finally, the link between hypertensive complications or preterm delivery and the risk of long term cardiovascular events or death have been recently highlighted [11].…”