Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease.

BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, p = 0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.

Uso de la matriz hemostática Floseal® en el control de la hemorragia obstétrica: estudio de seguimiento y costos asociados con el tratamiento / Use of Floseal® hemostatic matrix in the management of obstetric hemorrhage: A follow-up and costs related to treatment

Resumen OBJETIVO Evaluar cómo se atendieron las pacientes con hemorragia obstétrica, qué recursos se utilizaron y los costos directos relacionados con el tratamiento de pacientes con placenta previa, con o sin placenta acreta, en quienes se indicó Floseal® como parte de las medidas de control e inhibición de la hemorragia en comparación con quienes solo recibieron los cuidados convencionales. MATERIALES Y MÉTODOS Estudio retrospectivo, observacional y comparativo de los expedientes clínicos de pacientes adultas con más de 20 semanas de gestación y placenta previa tratadas entre septiembre y noviembre del 2012 en la Unidad Médica de Alta Especialidad 23 en Monterrey, México. Los resultados clínicos y costos se compararon con pruebas paramétricas y no paramétricas. RESULTADOS Se analizaron 29 expedientes (15: Floseal® coadyuvante, 14: solo con tratamiento convencional). El grupo tratado con Floseal® tuvo menos reintervenciones (0 vs 57.1%, p 0.0010), días de estancia hospitalaria [2(2-4) vs 6(4-11), p 0.0048] y cuidados intensivos (2.4 ± 1.5 vs 4.5 ± 2.1, p 0.0048). El costo promedio por remuestreo fue de 109,172.00 pesos mexicanos (IC95%: 80,153.10-139,073.71 pesos) para Floseal® vs 224,289.00 pesos mexicanos (IC95%: 181,881.48-269,061.23 pesos) para el tratamiento convencional a expensas de un número de piezas mayor de Tisseel®, crioprecipitados, cristaloides y retiro quirúrgico de compresas. CONCLUSIONES El uso coadyuvante de Floseal® se asoció con menor número de reintervenciones, días de estancia hospitalaria y atención en cuidados intensivos. Se registraron menores costos promedio y total asociados con la atención. Para corroborar estos resultados en población mexicana se requieren análisis de largo seguimiento y con muestras más grandes.

Abstract OBJECTIVE To evaluate the clinical outcomes and direct costs related to treatment of placenta previa with Floseal® hemostatic matrix as part of the treatment of obstetric hemorrhage in comparison with conventional management only. METHODS Clinical records of patients with hemorrhagic hemorrhage, with more than 20 weeks of pregnancy and placenta previa were reviewed, all patients were adults and treated within September and November of 2012 in the "Unidad Médica de Alta Especialidad 23" of the Mexican Institute of Social Security, Monterrey, México. Costs where estimated using the Diario Oficial de la Federación 2013) and a resampling was performed. Clinical and costs outcomes where compared with parametric and non-parametric tests. RESULTS 29 clinical records (15: Adjuvant Floseal®, 14: conventional treatment only). Floseal® group resulted in less re-interventions (0% vs 57.1%, p 0.0010), days of hospital stay [2(2-4) vs 6(4-11), p 0.0048] and days in the intensive care unit (2.4 ± 1.5 vs 4.5 ± 2.1, p 0.0048). Average cost by resampling was $109,172.00 [CI95% (80,153.10-139,073.71 mexican pesos)] for Floseal® vs 224,289.00 mexican pesos [IC95% (181,881.48-269,061.23)] for conventional treatment at the expense greater number of pieces of Tisseel®, cryoprecipitate, crystalloids and surgical removal of compresses. CONCLUSIONS The adjuvant use of Floseal® was associated with fewer re-interventions, days of hospital stay and intensive care. Lower average and total costs associated with treatment were also estimated. Future long-term analyzes and larger sample sizes are necessary to corroborate these results in the Mexican population.

Expression levels of seven candidate genes in human peripheral blood mononuclear cells and their association with preeclampsia.

OBJECTIVE: To evaluate the peripheral blood mononuclear cell (PBMC) expression levels of hemeoxygenase 1 (HMOX-1), superoxide dismutase 1 (SOD-1), vascular endothelial growth factor A (VEGF-A), transforming growth factor beta 1 (TGF-ß1), interleukin (IL)-6, IL-15 and AdipoQ genes to study their association with preeclampsia (PE). METHODS: A total of 177 pregnant women were recruited: 108 cases and 69 controls. Quantification of gene expression was measured by quantitative real-time polymerase chain reaction (PCR) using TaqMan probes. RESULTS: Underexpression of VEGF-A and TGF-ß1 was a constant in most of the cases (80.91% and 76.36%, respectively) and their expression was associated with onset and/or severity of disease (p values < 0.05). IL-6, IL-15 and AdipoQ, showed low or no expression in PBMC samples evaluated. CONCLUSION: PBMC underexpression of VEGF-A and TGF-ß1 is a hallmark of PE in the study population.