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1.
Presse Med ; 48(12): 1422-1430, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679895

RESUMO

Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.


Assuntos
Complicações Cardiovasculares na Gravidez , Parto Obstétrico/métodos , Parto Obstétrico/normas , Aconselhamento Diretivo/métodos , Feminino , Humanos , Mortalidade Materna , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , /terapia , Fatores de Risco , Vasodilatadores/uso terapêutico
2.
BMC Pregnancy Childbirth ; 19(1): 325, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484509

RESUMO

BACKGROUND: Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012-30/09/2016. METHODS: Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL). RESULTS: A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1-2 and 3-4, respectively (p = 0.165). CONCLUSIONS: Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.


Assuntos
Cardiopatias/epidemiologia , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Terceira Fase do Trabalho de Parto , Análise Multivariada , Gravidez , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
3.
Pregnancy Hypertens ; 17: 82-88, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487662

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) and preeclampsia are strongly associated, yet a description of risk factors for PPCM among women with preeclampsia is currently lacking. Additionally, the effect of preeclampsia on PPCM-related outcomes is not well known. METHODS: We constructed a cohort of delivery admissions from 2011 to 2014 using a large US administrative database (Marketscan). We assessed risk factors for the development of PPCM among women with preeclampsia. We compared the risks of major adverse cardiovascular events (MACE) at 6 months between PPCM with co-incident preeclampsia (pePPCM) and PPCM without preeclampsia (npePPCM). RESULTS: We included 1,024,035 pregnancies, of which 64,503 (6.3%) had preeclampsia. A total of 874 had PPCM (283 with preeclampsia and 591 without preeclampsia). Among women with preeclampsia, clinical risk factors for PPCM consisted in chronic kidney disease (OR 3.18, 95% CI [1.51, 6.69]), multiple pregnancy (OR 2.11, 95% CI [1.49, 2.98]), chronic hypertension (OR 1.88, 95% CI [1.43, 2.47]), advanced maternal age (OR 1.82, 95% CI [1.42, 2.33]), and type 2 diabetes (OR 1.58, 95% CI [1.00, 2.48]). Women with pePPCM had a higher risk of MACE than women with npePPCM (adjusted RR 1.29, 95% CI [1.06, 1.57]) due to increased rates of clinical heart failure and pulmonary embolism in the pePPCM group. Mortality did not differ between groups. CONCLUSION: Preeclamptic women with risk factors for PPCM and women with pePPCM at increased risk of MACE should be followed closely. Further studies are required to determine whether preeclampsia affects the long-term prognosis of women with PPCM.


Assuntos
Cardiomiopatias/epidemiologia , Seguro Saúde , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Cuidado Pré-Natal , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/economia , Estudos de Coortes , Bases de Dados Factuais , Parto Obstétrico , Feminino , Humanos , Período Periparto , Pré-Eclâmpsia/economia , Gravidez , Complicações Cardiovasculares na Gravidez/economia , Fatores de Risco , Estados Unidos/epidemiologia
4.
Pregnancy Hypertens ; 17: 94-99, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487664

RESUMO

OBJECTIVES: To estimate the incidence of hypertension and the trend of systolic and diastolic blood pressure changes and relating factors influencing women with and without prior preeclampsia (PE). STUDY DESIGN: This prospective population based study included a total of 3022 eligible women (355 with PE and 2667 non-PE) recruited from participants of the Tehran Lipid and Glucose Study (TLGS) who were assessed for progression to subsequent hypertension over 15-year follow up. Pooled logistic regression model was utilized to estimate odds ratio (OR) of hypertension. The generalized estimating equation (GEE) was used to evaluate the trend of changes in hypertension parameters over time. RESULTS: At the end of follow-ups, 109 women (30.7%) in the PE group and 575 (21.5%) in the non-PE group had hypertension. The total cumulative incident rate of hypertension was 34/1000 person-years for PE groups and 22/1000 person years for non-PE groups (P < 0.001). Pooled logistic regression analysis showed that compared to non-PE women, OR of hypertension progression in women with PE was 3.70 after adjustment for age, body mass index (BMI), parity, triglycerides (TG) and high-density lipoprotein (HDL-C) (P-value < 0.001). Based on GEE analysis, mean changes of systolic and diastolic blood pressure in PE women increased by 4.66 and 2.55 mmHg, respectively, compared to the non-PE group, after adjustment for age, and BMI at baseline (P < 0.001), although the interaction term (follow-up year × PE) was not statistically significant. CONCLUSION: This study demonstrated increased chances of developing hypertension among women with prior PE, particularly in those who develop additional risk factors in their later life, compared to the non-PE women. While the trajectory of blood pressure change over time is similar between women with and without preeclampsia, women with a history of preeclampsia consistently have higher levels of blood pressure.


Assuntos
Pressão Sanguínea/fisiologia , Pré-Eclâmpsia/epidemiologia , Cuidado Pré-Natal , Adulto , Determinação da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Prospectivos , Adulto Jovem
5.
BMC Res Notes ; 12(1): 491, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391105

RESUMO

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.


Assuntos
Cardiomiopatias/epidemiologia , Comunicação Interatrial/epidemiologia , Comunicação Interventricular/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Isquemia Miocárdica/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/diagnóstico , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Unidades Hospitalares , Humanos , Hipertensão Pulmonar/diagnóstico , Iraque/epidemiologia , Isquemia Miocárdica/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Prevalência
6.
BMC Pregnancy Childbirth ; 19(1): 271, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370813

RESUMO

BACKGROUND: To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. METHODS: A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. RESULTS: A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74-5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45-5.82). CONCLUSIONS: The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Near Miss/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Sepse/epidemiologia , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Maternidades , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez de Alto Risco , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Infecção Puerperal/epidemiologia , Fatores de Risco , Tempo para o Tratamento , Hemorragia Uterina/epidemiologia , Inércia Uterina/epidemiologia , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 19(1): 294, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409379

RESUMO

BACKGROUND: The risk of venous thromboembolism (VTE) during pregnancy and puerperal periods is significantly higher than during the non-pregnant period and is one of the major causes of maternal mortality. Developed countries have promulgated guidelines for risk assessment and prevention of maternal VTE, and standardized management has led to a significant reduction in maternal mortality. However, there is a paucity of relevant research related to pregnancy and puerperal VTE in China. METHODS/DESIGN: We will perform a prospective cohort study and recruit 13,000 pregnant women from 2018 to 2020 in Beijing, China. VTE risk assessment will be conducted using the Royal College of Obstetricians and Gynaecologists (RCOG) pregnancy and puerperal VTE risk-assessment-scoring tool during early and late pregnancy, as well as during the puerperal period. Venous ultrasonography of lower extremities, routine blood tests, and coagulation parameters will be examined. These VTE risk assessments will be performed again if patients have VTE-related symptoms during their pregnancies, or if any of the following occur: (1) patients are hospitalized over 7 days due to any pregnancy complications; (2) patients are placed under strict bed rest for ≥ 3 days to prevent miscarriage. For patients with a confirmed diagnosis of VTE, treatment and follow-up plans will be decided jointly by the obstetricians, vascular surgeons, and pulmonologists. All patients in the study will be followed up by dedicated healthcare providers for up to 42 days postpartum. Statistical analyses will be performed to test the feasibility of the RCOG scoring tool for the Chinese population. The RCOG scoring tool will then be revised based upon the characteristics of the Chinese population, and the revised assessment scoring tool will then be tested in the cohort to evaluate its efficacy. Finally, a pregnancy and puerperal VTE risk-assessment tool will be proposed based on our study results. DISCUSSION: This study will establish a preliminary VTE risk-assessment tool that is applicable to pregnant and puerperal women in China and provide guidelines for further thrombophylactic interventions. Furthermore, we wish to draw increased attention to pregnancy-associated VTE to reduce VTE-related mortality. TRIAL REGISTRATION: Chi CTR1800015848 (04/24/2018).


Assuntos
Complicações Cardiovasculares na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Embolia Pulmonar/epidemiologia , Medição de Risco/métodos , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Repouso em Cama , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Gravidez , Estudos Prospectivos
9.
Acta Med Port ; 32(6): 434-440, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31292024

RESUMO

INTRODUCTION: This study aimed to describe demographic, socioeconomic and pregnancy-related characteristics associated with a caesarean delivery in Luanda. MATERIAL AND METHODS: We conducted a cross-sectional study which included 995 puerperal women and who were assessed between December 2012 and February 2013 at Lucrécia Paím maternity hospital in Luanda, Angola. Data was collected using a structured questionnaire administered by trained interviewers. Logistic regression models were fitted to estimate the magnitude of associations (odds ratios-95% confidence intervals) between the type of delivery and variables showing a significant association in the bivariate analysis. RESULTS: The prevalence of caesarean section was 44%. Women with caesarean delivery were less educated, resided more often in a periurban area and were more likely to disclose lower family income when compared with women who had vaginal delivery. Living in a periurban area was significantly associated with a caesarean delivery regardless of all covariates considered, for primiparous women (adjusted odds ratios, 95% confidence intervals = 2.14, 1.27 - 3.62) and for multiparous women (1.78, 1.26 - 2.51). Among multiparous women, a lower family income was also significantly associated with caesarean delivery. Hypertensive disorders during the current pregnancy were associated with a caesarean delivery in the multivariate models fitted for primiparous (3.96, 1.57 - 9.98) and for multiparous women (1.68, 1.03 - 2.74). DISCUSSION: The associations between low socioeconomic position and high risk of caesarean delivery demonstrated in this study are consistent results in previous researches curried out in African contexts. The poorer and less educated women, who live far from health facilities, have few antenatal care visits and often arrive with complicated conditions, justifying a caesarean delivery. Lack of qualified human and material resources to manage emergencies in peripheral health centers and delaying in the reference system also leads to an increase in the number of caesareans performed in this particular maternity hospital. CONCLUSION: Sociodemographic differences were observed according to the type of delivery. Cesarean section was more prevalent among women with lower income and residents in periurban areas.


Assuntos
Cesárea/estatística & dados numéricos , Adolescente , Adulto , Angola , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Escolaridade , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Idade Materna , Razão de Chances , Paridade , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Análise de Regressão , Fatores Socioeconômicos , População Suburbana/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
10.
Biomed Res Int ; 2019: 2957429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355253

RESUMO

Objectives: This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum. Methods: This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants' cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated. Results: A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01. Conclusion: Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy.


Assuntos
Ganho de Peso na Gestação , Complicações Cardiovasculares na Gravidez , Adulto , Feminino , Seguimentos , Humanos , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Fatores de Risco , Arábia Saudita/epidemiologia
11.
Congenit Heart Dis ; 14(5): 735-744, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207185

RESUMO

BACKGROUND: The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. OBJECTIVE: To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. METHODS: The Quebec CHD database was used to construct a cohort with all women with CHD aged 18-45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1-year health care use following delivery. RESULTS: About 14 878 women were included. A total of 10 809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P < .05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac-hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). CONCLUSIONS: Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population.


Assuntos
Aborto Espontâneo/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Cardiopatias Congênitas/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Cardiovasculares na Gravidez/epidemiologia , Taxa de Gravidez/tendências , Sistema de Registros , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Quebeque/epidemiologia , Adulto Jovem
12.
Rev Port Cardiol ; 38(5): 373-383, 2019 05.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31227292

RESUMO

The association between heart disease and pregnancy is increasingly prevalent. Although most women with heart disease tolerate the physiological changes of pregnancy, there are heart conditions that manifest for the first time during pregnancy and others that totally contraindicate a pregnancy. It is therefore important to establish multidisciplinary teams dedicated to the management of women with heart disease who intend to become, or who already are, pregnant. The aim of this article is to systematically review current knowledge on the approach to women with high-risk cardiovascular disease during pregnancy.


Assuntos
Cardiopatias/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Feminino , Saúde Global , Humanos , Gravidez , Prevalência
13.
JAMA Netw Open ; 2(5): e193667, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31074818

RESUMO

Importance: With the help of medical advances, more women with adult congenital heart disease (ACHD) are becoming pregnant. Adverse maternal, obstetric, and neonatal events occur more frequently in women with ACHD than in the general obstetric population. Adult congenital heart disease is heterogeneous, yet few studies have assessed whether maternal and neonatal outcomes differ across ACHD subtypes. Objective: To assess the association of ACHD and its subtypes with pregnancy, maternal, and neonatal outcomes. Design, Setting, and Participants: This cross-sectional study used data from the Discharge Abstract Database, which contains information on all hospitalizations in Canada (except Quebec) from fiscal years 2001-2002 through 2014-2015. Discharge Abstract Database information was linked with maternal and infant hospital records across Canada. All women who gave birth in hospitals during the study period were included in the study. Data were analyzed from December 18, 2017, to March 22, 2019. Exposures: Women with ACHD were identified using diagnostic and procedural codes. Subtypes of ACHD were classified using the Anatomic and Clinical Classification of Congenital Heart Defects scheme. Main Outcomes and Measures: Primary outcomes were defined a priori and included severe maternal morbidity (measured using the Maternal Morbidity Outcomes Indicator), neonatal morbidity and mortality (measured using the Neonatal Adverse Outcomes Indicator), ischemic placental disease, preterm birth, congenital anomalies, and small-for-gestational-age births. Absolute and relative rates of each outcome were calculated overall and by ACHD subtype. Logistic regression using generalized estimating equations assessed crude and adjusted odds ratios (aORs) for each outcome in women with ACHD compared with women without ACHD after adjustment for comorbidities, mode of delivery, and study year. Results: The 2114 women with ACHD included in the analysis (mean [SD] age, 29.4 [5.7] years) had significantly higher odds of maternal morbidity (aOR, 2.7; 95% CI, 2.2-3.4) and neonatal morbidity and mortality (aOR, 1.8; 95% CI, 1.6-2.1) compared with women without ACHD (n = 2 682 451). Substantial variation was observed between women with different subtypes of ACHD. For example, the aORs of preterm birth (<37 weeks) varied from 0.4 (95% CI, 0.4-0.5) for women with anomalies of atrioventricular junctions and valves to 4.7 (95% CI, 2.9-7.5) for women with complex anomalies of atrioventricular connections. Conclusions and Relevance: These results suggest that women with different subtypes of ACHD are not uniformly at risk for adverse maternal and neonatal outcomes. Although some women with ACHD can potentially expect healthy pregnancies, it appears that clinical care should be modified to address the heightened risks of certain ACHD subtypes.


Assuntos
Cardiopatias Congênitas/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Canadá/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Cardiopatias Congênitas/complicações , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco , Adulto Jovem
14.
Eur J Obstet Gynecol Reprod Biol ; 238: 7-11, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082745

RESUMO

A meta-analysis based on published literature was undertaken to evaluate the efficacy of anticoagulant drugs for the treatment of venous thromboembolism during pregnancy. PubMed, Cochrane and Embase databases were searched from inception to September 2018 for relevant studies using indexed words, including qualified case-control and cohort studies. The meta-analysis used odds ratios (OR) and 95% confidence intervals (95% CI) to analyse the primary results. Nine studies were included in this meta-analysis, with a total of 834 cases and 3424 controls. There were no significant differences in the incidence of prenatal haemorrhage (OR 1.08, 95% CI 0.84-1.40), venous thromboembolism (OR 1.30, 95% CI 0.72-2.33) or caesarean section (OR 1.16, 95% CI 0.69-1.98) between the case group and the control group. The incidence of pulmonary embolism was significantly higher in the case group than in the control group (OR 3.90, 95% CI 1.23-12.34). However, there were a few limitations that may have influenced the results, so more randomized double-blind controlled studies of high quality are warranted to confirm the efficacy of anticoagulant therapy for venous thromboembolism in pregnancy.


Assuntos
Anticoagulantes/uso terapêutico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Tromboembolia Venosa/tratamento farmacológico , Cesárea/estatística & dados numéricos , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Embolia Pulmonar/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
15.
Eur J Obstet Gynecol Reprod Biol ; 237: 145-150, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31051417

RESUMO

BACKGROUND: Maternal cardiac arrest is a complex and demanding clinical situation requiring a well-attuned team effort of healthcare workers of multiple disciplines. A recent report on maternal cardiac arrest in the United Kingdom reported a rise in incidence over a span of 10 years, while maternal mortality increased in the United States between 2000 and 2014. However, reported causes of maternal cardiac arrest differed between both countries. OBJECTIVE(S): To determine the incidence, causes and management of maternal cardiac arrest in the Netherlands and compare incidence with previous estimates in the Netherlands and the United Kingdom. STUDY DESIGN: Using the Netherlands Obstetric Surveillance System, all Dutch cases of maternal cardiac arrest during a three-year period (2013-2016) were prospectively collected. Complete casefile copies were obtained for analysis. Main outcome measures were incidence of maternal cardiac arrest and cardiac arrest in pregnancy, use of perimortem caesarean section if appropriate and maternal death. RESULTS: The monthly card return rate was 97%; 18 women with cardiac arrest during pregnancy and 20 postpartum met the inclusion criteria. Incidence of maternal cardiac arrest was 7.6 per 100,000 pregnancies and 3.6 per 100,000 pregnancies excluding postpartum maternal cardiac arrest. Main causes were pulmonary embolism (n = 9), major obstetric hemorrhage (n = 7) and amniotic fluid embolism (n = 6). Aortocaval compression relief and perimortem caesarean section were performed in 9/14 (29%) and 11/14 (79%) respectively in pregnancies 20 weeks gestational age onwards. Twenty-two women died, representing a case fatality rate of 58% (95% CI 42-72%). CONCLUSION(S): There is a higher incidence of cardiac arrest in pregnancy compared to both previous estimates in the Netherlands and recently established figures in the United Kingdom. Main causes of maternal cardiac arrest are potentially preventable and/or treatable complications of pregnancy. Insufficient use of critical elements of obstetric resuscitation identifies the need for enhanced obstetric emergency training for obstetric and non-obstetric first responders.


Assuntos
Parada Cardíaca/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Incidência , Mortalidade Materna , Países Baixos/epidemiologia , Gravidez , Fatores de Risco
16.
Int J Gynaecol Obstet ; 145(3): 324-330, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932184

RESUMO

OBJECTIVE: To develop a model for predicting cardiac risk among pregnant women with structural heart disease in Eastern China. METHODS: The model was built using data from pregnant women (development cohort, n=566; validation cohort, n=314) who delivered at Shanghai Obstetrical Cardiology Intensive Care Center, Renji Hospital, Shanghai, between 2002 and 2015. Independent predictors of adverse cardiac events were determined by logistic regression. Discrimination and calibration of the model, termed the Renji score, were compared with the CARPREG score, ZAHARA score, and modified WHO risk classification. RESULTS: There were 87 (15.4%) adverse cardiac events in the development cohort. Independent predictors of adverse cardiac events included left ventricular systolic dysfunction (ejection fraction, <40%), prior cardiac event or arrhythmia, moderate-to-severe pulmonary arterial hypertension (≥50 mm Hg), mechanical valve replacement, moderate-to-severe mitral stenosis. Surgical intervention before pregnancy was protective against cardiac events. As compared with other risk assessment systems, the Renji score performed better in predicting cardiac events, with a concordance statistic of 0.844 (95% confidence interval [CI], 0.800-0.889) for the development cohort and 0.779 (95% CI, 0.684-0.873) for the validation cohort. CONCLUSION: The Renji score was applicable to predicting cardiac events among pregnant women with structural heart disease in Eastern China.


Assuntos
Cardiopatias Congênitas/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , China , Feminino , Humanos , Modelos Logísticos , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
17.
Am J Cardiol ; 123(12): 2006-2014, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30967289

RESUMO

There is limited data on postpartum maternal postpartum major adverse cardiovascular and cerebrovascular events (MACCE) among women with heart disease (HD) in the US. Therefore, we aimed to determine the prevalence and predictors of MACCE in the US. The Nationwide Readmissions Databases (2010 to 2014) were screened for patients with and without HD undergoing delivery. HD subtypes included cardiomyopathy (CDM), congenital heart disease, valvular heart disease, and pulmonary hypertension. Rates and reasons of 42-day readmission were determined using weighted national estimates. Independent predictors of postpartum MACCE were determined using multivariable logistic regression for complex survey data. We found among 15,273,247 patients hospitalized for delivery, 33,827 had HD (CDM 22.78%, congenital heart disease 45.98%, valvular heart disease 24.81%, and pulmonary hypertension 6.41%). Of these, 5.2% of HD patients and 1.4% of No HD were readmitted. MACCE was higher in HD vs No HD (2.68% vs 0.17%, p <0.0001). Median time to MACCE was 5.6 days (interquartile range 3 to 15 days). CDM had >10% readmission at 42 days. Among HD patients, cardiovascular, infectious, hypertensive syndromes, and complications of pregnancy were the most common reasons for 42-day readmission. MACCE predictors in women with HD included HD subtype, age, insurance status, obesity, eclampsia, postpartum hemorrhage, MACCE during delivery, preterm delivery, and thrombotic complications. In conclusion, among a nationwide analysis, postpartum MACCE was more common among patients with HD especially within 1 week of discharge from delivery. Predictors can be easily screened for by clinicians, including presence of any HD, hypertensive syndromes, age, obesity, and obstetrical events during index hospitalization.


Assuntos
Cardiomiopatias/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Adulto , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Gravidez , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Int Heart J ; 60(3): 503-511, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019181

RESUMO

Peripartum cardiomyopathy (PPCM) is a specific cardiomyopathy in which heart failure develops due to reduced myocardial contraction during pregnancy or in the postpartum period in women without a previous history of heart disease. The epidemiology of PPCM has been reported in various countries and areas, and the incidence of PPCM differed among these reports. The incidence was highest (1 in 102 deliveries) in Nigeria and lowest (1 in 15,533 births) in Japan. The incidence was higher in African-Americans than in other races in several reports from the United States, and was also high in African countries and Haiti, indicating that the risk for PPCM is highest in the black race. However, the study design and definition of PPCM differ among studies, and these differences may influence the incidence. Moreover, the incidence of PPCM and the maternal mortality rate were well correlated. Since maternal mortality reflects the level of perinatal health care and hygiene, this finding suggests that the extent of perinatal care is partly related to the incidence of PPCM, which reflects heart failure and cardiomyopathy of unknown cause in women.


Assuntos
Cardiomiopatias/etiologia , Mortalidade Materna/tendências , Complicações Cardiovasculares na Gravidez/epidemiologia , Cardiomiopatias/epidemiologia , Cardiomiopatias/mortalidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Mortalidade Materna/etnologia , Nigéria/epidemiologia , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Projetos de Pesquisa , Estados Unidos/etnologia
19.
Health Care Women Int ; 40(10): 1117-1131, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30951435

RESUMO

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in women worldwide. Apart from the well-established risk factors, some adverse pregnancy outcomes have been found to be associated with increased risk of CVD in women. We reviewed the literature on the risk of CVD in women with a history of pregnancy loss (miscarriage and/or stillbirth). Electronic databases including MEDLINE and CINAHL were searched for English language articles published from 2000 to July 2016. Following the application of study inclusion and exclusion criteria, we selected seven studies for review. Women with history of miscarriage and/or stillbirth are more likely to develop coronary heart disease (CHD), but not stroke in their later life compared with women without these conditions. The risk is particularly greater in women with multiple miscarriages or stillbirths. Health professionals should be aware of the risk associated with miscarriage and stillbirth, and use maternal history to identify, refer, closely monitor, and engage these high risk women in healthy lifestyle and risk factor modification programs.


Assuntos
Aborto Espontâneo/epidemiologia , Doenças Cardiovasculares/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Aborto Induzido/estatística & dados numéricos , Doença das Coronárias/complicações , Feminino , Humanos , Gravidez , Resultado da Gravidez , Medição de Risco , Fatores de Risco , Natimorto/epidemiologia
20.
Eur J Obstet Gynecol Reprod Biol ; 236: 75-78, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30884339

RESUMO

BACKGROUND: Although stroke is more common with advancing age, especially in the elderly, women of reproductive age may still suffer from stroke, and from its deleterious consequences. Women of reproductive age who suffer a stroke may do so either due to a specific predisposition, or due to pregnancy-related hypertensive emergencies. OBJECTIVE: To assess the risk of stroke recurrence in pregnancy and the postpartum period in women who have suffered a stroke before pregnancy. STUDY DESIGN: This was a retrospective cohort study conducted at Thomas Jefferson University Hospital from January 2005 to December 2015. This is a tertiary referral center for high-risk obstetrics and one of the largest stroke referral centers for neurosurgery. All consecutive pregnant women that had a viable pregnancy (≥24 weeks of gestation) and a history of stroke prior to pregnancy were identified. The primary outcome of this study was stroke recurrence in pregnancy or the postpartum period defined as 6 weeks after delivery. RESULTS: Forty-eight pregnancies with a history of stroke before pregnancy were identified in 24 women. Thirty-one pregnancies (64.6%) had a history of an ischemic stroke, 11 (22.9%) had a history of transient ischemic attack, and 6 (12.5%) had a history of a hemorrhagic stroke. There was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke. In the ischemic stroke group, 8 (25.8%) had recurrence in the non-pregnant state compared to none in the TIA and the hemorrhagic stroke group. CONCLUSION: There was no stroke recurrence during pregnancy or the postpartum period for the three groups of stroke.


Assuntos
Complicações Cardiovasculares na Gravidez/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Feminino , Humanos , Philadelphia/epidemiologia , Gravidez , Recidiva , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária
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