Pregnancy Outcomes and Risk Evaluation in a Contemporary Adult Congenital Heart Disease Cohort.

BACKGROUND: More women with congenital heart disease (CHD) are surviving to childbearing age. In this population, pregnancy results in a higher rate of adverse events for the mother and offspring. We sought to evaluate outcomes in our cohort and relate these to previously developed risk classifications. METHOD: We retrospectively reviewed all pregnancies occurring in our tertiary referral centre CHD cohort between 2007 and 2019 resulting in data from 128 pregnancies in 89 women. The mean age was 29±6 years. Underlying cardiac diagnoses were grouped according to the ESC Registry of Pregnancy and Cardiac disease (ROPAC) classification and baseline risk assessed as per the modified WHO classification. RESULTS: There were a wide range of underlying diagnoses and large number of moderate to high risk pregnancies with 57 (44.5%) classified as mWHO III or IV. There were no maternal deaths. The mean gestation at delivery was 37 weeks. The majority delivered vaginally. Adverse events occurred in 80 pregnancies (63%). Cardiovascular events in 21 (16%), obstetric 54 (42%) and neonatal 52 (41%). Common events included premature labour and delivery in 21 pregnancies (16%); post-partum haemorrhage in 33 (26%), small for gestational age infants in 38 (30%) and admission to the NICU in 23 (18%). Event rates increased in women classified as higher risk by mWHO group. CONCLUSION: Women with CHD have increased rates of adverse cardiovascular, obstetric and neonatal events in pregnancy. As expected, adverse outcomes occur more frequently in higher risk mWHO groups.

Development and Implementation of a Brain Rest Protocol in Nonintellectually Challenged Youth With Head-Banging Behaviors.

INTRODUCTION: Concussions as a result of mild traumatic brain injury (MTBI) in youth are often associated with athletic injury; however, they can also occur as a result of intentional self-injury by head banging. Despite the known neurological sequelae secondary to MTBI, assessment, interventions, and consequences of head banging in the nonintellectually disabled populations have not been well studied. AIMS: The intent of this nurse-led intervention was to develop a brain rest protocol at a residential treatment program serving youth who were between 12 and 19 years old in order to improve the quality of care and moderate negative sequelae resulting from MTBI. METHODS: A nursing assessment guided by an adaptation of the acute concussion evaluation and a strength-based intervention protocol was developed and applied to youth who engage in head banging. RESULTS: The result was a protocol that defined the process by which a youth would be assessed and treated after head banging. There are no outcome measures that would assist to measure the effectiveness of this intervention in the short or long term. CONCLUSION: This intervention filled a need for improved assessment and appropriate interventions in youth with head-banging behavior. It is feasible that the assessment and implementation of the brain rest protocol is the first step in understanding how to best evaluate and manage the sequelae of intentional head banging resulting from MTBI.

New atrial fibrillation diagnosed perioperatively-anticoagulation practices in a secondary hospital.

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia encountered perioperatively in patients undergoing non-cardiac surgery. There is emerging evidence suggesting high risk of ischaemic stroke. There are no clear guidelines surrounding initiation of anticoagulation in this setting. This study evaluates current practice in anticoagulant management of new perioperative AF at Hutt Hospital. METHODS: We have undertaken a retrospective study of 3,558 patients aged 60 years and over admitted for non-cardiac surgery at Hutt Hospital in 2014, to assess incidence of new AF/flutter and review how they were managed in regards to anticoagulation. RESULTS: We identified 28 patients as having "new AF/flutter" with CHA2DS2-VASc scores between 1 and 8. Anticoagulation management was inconsistent, with only some patients receiving anticoagulation if using CHA2DS2-VASc score as a marker of indication for treatment. CONCLUSIONS: There is insufficient evidence and lack of clear guidelines in this area to enable consistent and evidence-based management of patients with new AF identified perioperatively. Until such guidelines are available we suggest all such patients are individually assessed and treated depending on their individual risk/benefit analysis. Multiple factors such as bleeding risk, CHA2DS2-VASc score and perhaps duration of AF need to be considered.