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Kalp Hastalıkları Olan Gebelerin Değerlendirilmesi: Bir Üniversite Hastanesinin Üç Yıllık Deneyimi

Year 2018, Volume: 71 Issue: 3, 194 - 199, 25.12.2018

Hüseyin Ede

Abstract

Amaç: Bu çalışmanın esas amacı üçüncü basamak referans hastanesindeki kalp hastalığı olan gebeleri incelemek ve bunların fetal ve maternal
özelliklerini değerlendirmektir.

Gereç ve Yöntem: Retrospektif olarak 2013 ile 2015 yılları arasında daha önce kardiyak hastalığı olan 20 hafta veya daha üstü gebeliği olan gebeler
incelendi. Fetal ve maternal klinik veriler uygun biçimde elde edildi.

Bulgular: Hastanemizde toplam 6599 doğum gerçekleştirildi. Kardiyak hastalığı olan 120 gebe vardı. Gebeler arasında en sık görüleni romatizmal
kalp hastalığı (n=66, %55) idi; ikinci en sık olan kalp ritim bozuklukları idi (n=15, %12,5). On iki hastada konjestif kalp yetmezliği, 12 hastada
konjenital kalp hastalığı, 8 hastada aort kapak veya aort patolojisi, dört hastada pulmoner hipertansiyon, iki hastada koroner arter hastalığı ve bir
hastada perikardiyal efüzyon vardı. Üç gebenin sol ventrikül ejeksiyon fraksiyonu (LVEF) %35’in altında iken 6 gebenin LVEF değeri %35 ile %50 arası,
diğer gebelerin LVEF’si ise >%50 idi. Maternal ölüm görülmedi ancak 22 hasta (%18,3) postoperatif dönemde kardiyoloji yoğun bakım ünitesinde
takip edildi. İki olguda (%1,66) neonatal mortalite gelişirken 6 olguda (%5) neonatal morbidite oluştu. En sık doğum yöntemi sezeryan yoluyla
doğumdu (n=97, %81). Prematür doğum oranı %37,5 idi (n=45).

Sonuç: Kalp hastalığı olan gebeler, bu alanda deneyimli kardiyoloji, anestezi ve doğum uzmanından oluşan bir takımın yakın takibi olduğu sürece
maternal veya neonatal riskin azaltılmasıyla sağlıklı doğum yapma şansına sahiptirler.

Keywords

Kalp Hastalıkları ve Gebelik

Ethical Statement

Etik Kurul Onayı: Dicle Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (23.10.2015/45). Hasta Onayı: Çalışmaya dahil edilen tüm hastalardan aydınlatılmış onam alındı. Hakem Değerlendirmesi: Editörler kurulu ve editörler kurulu dışında olan kişiler tarafından değerlendirilmiştir. Yazarlık Katkıları Cerrahi ve Medikal Uygulama: S.A., T.G., Konsept: S.A., T.G., Dizayn: S.A., T.G., Veri Toplama ve İşleme: S.A., S.AK., C.P., H.E., T.G., Analiz veya Yorumlama: S.A., S.AK., C.P., H.E., T.G., Literatür Arama: S.A., S.AK., C.P., H.E., T.G., Yazan: : S.A., S.AK., C.P., H.E., T.G., Çıkar Çatışması: Yazarlar tarafından çıkar çatışması bildirilmemiştir. Finansal Destek: Yazarlar tarafından finansal destek almadıkları bildirilmiştir.

Supporting Institution

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Project Number

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Thanks

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References

  • 1. Weiss BM, von Segesser LK, Alon E, et al. Outcome of cardiovasculer surgery and pregnancy; a systematic review of the period 1984-1996. Am J Obstet Gynecol. 1998;179:1643-1653.
  • 2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-3241.
  • 3. Cheitlin MD. Cardiac problems in pregnancy. Maternal aspects to the pregnant patient with heart disease. JAMA. 1984;251:2838-2839.
  • 4. Phillips S, Pirics M. Congenital Heart Disease and Reproductive Risk: An Overview for Obstetricians, Cardiologists, and Primary Care Providers. Methodist Debakey Cardiovasc J. 2017;13:238-242.
  • 5. Mc Faul PB, Dorman JC, Lamki H. Pregnancy complicated by maternal heart disease. A review of 519 women. Br J Obstet Gynecol. 1988;95:861-868.
  • 6. Aydin E, Ozyuncu O, Kasapoglu D, et al. Clinical analyses of 383 cases with maternal cardiac diseases. J Perinat Med. 2018;46:293-298.
  • 7. Xu L, Liu X, Wu S, et al. The clinical application value of the plasma copeptin level in the assessment of heart failure with reduced left ventricular ejection fraction: A cross-sectional study. Medicine (Baltimore). 2018;97:e12610.
  • 8. Simpson LL. Maternal cardiac disease: update for the clinician. Obstet Gynecol. 2012;119:345-359.
  • 9. Berg CJ, Callaghan WM, Syverson C, et al. Pregnancy-related mortality in the US, 1998 to 2005. Obstet Gynecol. 2010;116:1302-1309.
  • 10. Small MJ, James AH, Kershaw T, et al. Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions. Obstet Gynecol. 2012;119:250-255.
  • 11. Fryar CD, Chen T, Li X. Prevalance of uncontrolled risk factors for cardiovascular disease: US, 1999-2010. NCHS Data Brief. 2012;103:1-8.
  • 12. Seshadri S, Oakeshott P, Nelson- Piercy C, et al. Pregnancy care. BMJ 2012;344:e3467.
  • 13. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515-521.
  • 14. Mc Faul PB, Dornan JC, Lamki H, et al. Pregnancy complicated by maternal heart disease: a review of 519 woman. Br J Obstet Gynaecol. 1988;95:861- 867.
  • 15. Madazli R, Şal V, Çift T, et al. Pregnancy outcomes in women with heartdisease. Arch Gynecol Obstet. 2010;281:29-34.
  • 16. Oron G, Hirsch R, Ben-Haroush A, et al. Pregnancy outcome in women with heart disease undergoing induction of labour. BJOG. 2004;111:669-675.
  • 17. Nassar AH, Hobeika EM, Abd Essamed HM, et al. Pregnancy outcome inwomen with prosthetic heart valves. Am J Obstet Gynecol. 2004;191:1009-1013.
  • 18. McLintock C. Anticoagulant therapy in pregnant women with mechanicalprosthetic heart valves: no easy option. Thromb Res. 2011;127:S56-60.
  • 19. Cotrufo M, De Feo M, De Santo LS, et al. Risk of warfarin during pregnancywith mechanical valve prostheses. Obstet Gynecol. 2002;99:35-40.
  • 20. Al-Talib TK, Liu SS, Srivastava M. Cardiovascular Emergencies in Pregnancy. Cardiol Clin. 2018;36:171-181.
  • 21. Freidman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. 2008;6:235-248.
  • 22. Datt V, Tempe DK, Virmani S, et al. Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure. Ann Card Anaesth. 2010;13:64-68.
  • 23. Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37:893-899.
  • 24. Kizer JR, Devereux RB, Patent foramen ovale in young adults with unexplained stroke. N Engl J Med. 2005;353:2361-2372.
  • 25. Curry RA, Fletcher C, Gelson E, et al. Pulmonary hypertension and pregnancya review of 12 pregnancies in nine women. BJOG. 2012;119:752-761.
  • 26. Weiss BM, Zemp L, Seifert B, et al. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650-1657.
  • 27. Patten IS, Rana S, Shahul S, et al. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012;485:333-338.
  • 28. Cunningham FG. Peripartum cardiomyopathy: we’ve come a long way, but… Obstet Gynecol 2012;120:992-994.
  • 29. Gunderson EP, Croen LA, Chiang V, et al. Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes. Obstet and Gynecol. 2011;118:583-591.
  • 30. Mielniczuk LM, Williams K, Davis DR, et al. Peripartum cardiomyopathy: frequency of peripartum cardiomyopathy. Am J Cardiol. 2006;97:1765- 1768.
  • 31. Gowda RM, Khan IA, Mehta NJ, et al. Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. Int J Cardiol. 2003;88:129-133.
  • 32. Robins K, Lyons G. Supraventricular tachycardia in pregnancy. Br J Anaesth 2004;92:140-143.
  • 33. Maxwell C, Poppas A, Sermer M. Heart disease in pregnancy. In Powrie R, Greene MF, Camann W (eds): de Swiet’s Medical Disorders, 5th ed. Wiley- Blackwell, Oxford, 2010, p 118.
  • 34. Ladner HE, Danielser B, Gilbert WM. Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Obstet Gynecol. 2005;105:480-484.

The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital

Year 2018, Volume: 71 Issue: 3, 194 - 199, 25.12.2018

Hüseyin Ede

Abstract

Objectives: The main purpose of our study is to examine cases of pregnant patients with heart diseases in our tertiary referral hospital and to
evaluate fetal and maternal outcomes.

Materials and Methods: Pregnants with gestational age of 20 weeks or more and with any previous cardiac diseases were examined between 2013
and 2015 retrospectively. Fetal and maternal clinical data were collected accordingly.

Results: In total, 6599 live births were carried out in our hospital. Of them, there were 120 pregnants with cardiac disease. Rheumatic valvular
heart disease was the most common (n=66, 55%) disorder among the pregnants, followed by the heart rhythm disorders respectively (n=15; 12.5%).
Twelve patients had congestive heart failure; twelve patients with congenital heart disease, eight patients with aort valve or aorta pathology; four
with pulmonary hypertension, two with coronary artery disease and one with pericardial effusion. Three pregnants had left ventricular ejection
fraction (LVEF) of less than 35%, six pregnants had LVEF between 35 to 50% and the rest of the pregnants had LVEF of >50%. Maternal death
was not encountered, 22 patients (18.3%) were followed in cardiology intensive care unit postoperatively. Neonatal mortality was developed in 2 cases (1.66%) and the neonatal morbidity was developed in 6 cases (5%). The most common form of delivery was caesarean section (n=97, 81%).
Premature birth ratio was 37.5% (n=45).

Conclusion: Pregnants with heart disease have chance to give healthy births with low risk for maternal or neonatal complications provided close
follow-up by a team of cardiologist, anesthetist, and obstetrician experienced in this field

Keywords

Heart Disease Pregnancy Maternal Morbidity

Project Number

-

References

  • 1. Weiss BM, von Segesser LK, Alon E, et al. Outcome of cardiovasculer surgery and pregnancy; a systematic review of the period 1984-1996. Am J Obstet Gynecol. 1998;179:1643-1653.
  • 2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-3241.
  • 3. Cheitlin MD. Cardiac problems in pregnancy. Maternal aspects to the pregnant patient with heart disease. JAMA. 1984;251:2838-2839.
  • 4. Phillips S, Pirics M. Congenital Heart Disease and Reproductive Risk: An Overview for Obstetricians, Cardiologists, and Primary Care Providers. Methodist Debakey Cardiovasc J. 2017;13:238-242.
  • 5. Mc Faul PB, Dorman JC, Lamki H. Pregnancy complicated by maternal heart disease. A review of 519 women. Br J Obstet Gynecol. 1988;95:861-868.
  • 6. Aydin E, Ozyuncu O, Kasapoglu D, et al. Clinical analyses of 383 cases with maternal cardiac diseases. J Perinat Med. 2018;46:293-298.
  • 7. Xu L, Liu X, Wu S, et al. The clinical application value of the plasma copeptin level in the assessment of heart failure with reduced left ventricular ejection fraction: A cross-sectional study. Medicine (Baltimore). 2018;97:e12610.
  • 8. Simpson LL. Maternal cardiac disease: update for the clinician. Obstet Gynecol. 2012;119:345-359.
  • 9. Berg CJ, Callaghan WM, Syverson C, et al. Pregnancy-related mortality in the US, 1998 to 2005. Obstet Gynecol. 2010;116:1302-1309.
  • 10. Small MJ, James AH, Kershaw T, et al. Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions. Obstet Gynecol. 2012;119:250-255.
  • 11. Fryar CD, Chen T, Li X. Prevalance of uncontrolled risk factors for cardiovascular disease: US, 1999-2010. NCHS Data Brief. 2012;103:1-8.
  • 12. Seshadri S, Oakeshott P, Nelson- Piercy C, et al. Pregnancy care. BMJ 2012;344:e3467.
  • 13. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515-521.
  • 14. Mc Faul PB, Dornan JC, Lamki H, et al. Pregnancy complicated by maternal heart disease: a review of 519 woman. Br J Obstet Gynaecol. 1988;95:861- 867.
  • 15. Madazli R, Şal V, Çift T, et al. Pregnancy outcomes in women with heartdisease. Arch Gynecol Obstet. 2010;281:29-34.
  • 16. Oron G, Hirsch R, Ben-Haroush A, et al. Pregnancy outcome in women with heart disease undergoing induction of labour. BJOG. 2004;111:669-675.
  • 17. Nassar AH, Hobeika EM, Abd Essamed HM, et al. Pregnancy outcome inwomen with prosthetic heart valves. Am J Obstet Gynecol. 2004;191:1009-1013.
  • 18. McLintock C. Anticoagulant therapy in pregnant women with mechanicalprosthetic heart valves: no easy option. Thromb Res. 2011;127:S56-60.
  • 19. Cotrufo M, De Feo M, De Santo LS, et al. Risk of warfarin during pregnancywith mechanical valve prostheses. Obstet Gynecol. 2002;99:35-40.
  • 20. Al-Talib TK, Liu SS, Srivastava M. Cardiovascular Emergencies in Pregnancy. Cardiol Clin. 2018;36:171-181.
  • 21. Freidman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. 2008;6:235-248.
  • 22. Datt V, Tempe DK, Virmani S, et al. Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure. Ann Card Anaesth. 2010;13:64-68.
  • 23. Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37:893-899.
  • 24. Kizer JR, Devereux RB, Patent foramen ovale in young adults with unexplained stroke. N Engl J Med. 2005;353:2361-2372.
  • 25. Curry RA, Fletcher C, Gelson E, et al. Pulmonary hypertension and pregnancya review of 12 pregnancies in nine women. BJOG. 2012;119:752-761.
  • 26. Weiss BM, Zemp L, Seifert B, et al. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650-1657.
  • 27. Patten IS, Rana S, Shahul S, et al. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012;485:333-338.
  • 28. Cunningham FG. Peripartum cardiomyopathy: we’ve come a long way, but… Obstet Gynecol 2012;120:992-994.
  • 29. Gunderson EP, Croen LA, Chiang V, et al. Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes. Obstet and Gynecol. 2011;118:583-591.
  • 30. Mielniczuk LM, Williams K, Davis DR, et al. Peripartum cardiomyopathy: frequency of peripartum cardiomyopathy. Am J Cardiol. 2006;97:1765- 1768.
  • 31. Gowda RM, Khan IA, Mehta NJ, et al. Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. Int J Cardiol. 2003;88:129-133.
  • 32. Robins K, Lyons G. Supraventricular tachycardia in pregnancy. Br J Anaesth 2004;92:140-143.
  • 33. Maxwell C, Poppas A, Sermer M. Heart disease in pregnancy. In Powrie R, Greene MF, Camann W (eds): de Swiet’s Medical Disorders, 5th ed. Wiley- Blackwell, Oxford, 2010, p 118.
  • 34. Ladner HE, Danielser B, Gilbert WM. Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Obstet Gynecol. 2005;105:480-484.
There are 34 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Articles
Authors

Hüseyin Ede 0000-0003-1218-257X

Project Number -
Publication Date December 25, 2018
Published in Issue Year 2018 Volume: 71 Issue: 3

Cite

APA Ede, H. (2018). The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(3), 194-199. https://doi.org/10.4274/atfm.88598
AMA Ede H. The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital. Ankara Üniversitesi Tıp Fakültesi Mecmuası. December 2018;71(3):194-199. doi:10.4274/atfm.88598
Chicago Ede, Hüseyin. “The Evaluation of the Pregnants With Cardiac Disorders: Three-Year Experience of an University Hospital”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, no. 3 (December 2018): 194-99. https://doi.org/10.4274/atfm.88598.
EndNote Ede H (December 1, 2018) The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 3 194–199.
IEEE H. Ede, “The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 3, pp. 194–199, 2018, doi: 10.4274/atfm.88598.
ISNAD Ede, Hüseyin. “The Evaluation of the Pregnants With Cardiac Disorders: Three-Year Experience of an University Hospital”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/3 (December 2018), 194-199. https://doi.org/10.4274/atfm.88598.
JAMA Ede H. The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:194–199.
MLA Ede, Hüseyin. “The Evaluation of the Pregnants With Cardiac Disorders: Three-Year Experience of an University Hospital”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 3, 2018, pp. 194-9, doi:10.4274/atfm.88598.
Vancouver Ede H. The Evaluation of the Pregnants with Cardiac Disorders: Three-Year Experience of an University Hospital. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(3):194-9.
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