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1.
Obstet Gynecol ; 136(5): 1072-1073, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093423

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
2.
Obstet Gynecol ; 136(5): e90-e99, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093425

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
3.
Acta Obstet Gynecol Scand ; 99(9): 1110-1120, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32678949

RESUMO

Those who are infected with Severe Acute Respiratory Syndrome-related CoronaVirus-2 are theoretically at increased risk of venous thromboembolism during self-isolation if they have reduced mobility or are dehydrated. Should patients develop coronavirus disease (COVID-19) pneumonia requiring hospital admission for treatment of hypoxia, the risk for thromboembolic complications increases greatly. These thromboembolic events are the result of at least two distinct mechanisms - microvascular thrombosis in the pulmonary system (immunothrombosis) and hospital-associated venous thromboembolism. Since pregnancy is a prothrombotic state, there is concern regarding the potentially increased risk of thrombotic complications among pregnant women with COVID-19. To date, however, pregnant women do not appear to have a substantially increased risk of thrombotic complications related to COVID-19. Nevertheless, several organizations have vigilantly issued pregnancy-specific guidelines for thromboprophylaxis in COVID-19. Discrepancies between these guidelines reflect the altruistic wish to protect patients and lack of high-quality evidence available to inform clinical practice. Low molecular weight heparin (LMWH) is the drug of choice for thromboprophylaxis in pregnant women with COVID-19. However, its utility in non-pregnant patients is only established against venous thromboembolism, as LMWH may have little or no effect on immunothrombosis. Decisions about initiation and duration of prophylactic anticoagulation in the context of pregnancy and COVID-19 must take into consideration disease severity, outpatient vs inpatient status, temporal relation between disease occurrence and timing of childbirth, and the underlying prothrombotic risk conferred by additional comorbidities. There is currently no evidence to recommend the use of intermediate or therapeutic doses of LMWH in thromboprophylaxis, which may increase bleeding risk without reducing thrombotic risk in pregnant patients with COVID-19. Likewise, there is no evidence to comment on the role of low-dose aspirin in thromboprophylaxis or of anti-cytokine and antiviral agents in preventing immunothrombosis. These unanswered questions are being studied within the context of clinical trials.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Fibrinolíticos/uso terapêutico , Pneumonia Viral/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Trombose/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez/virologia , Trombose/virologia
4.
Rev. chil. obstet. ginecol. (En línea) ; 85(2): 185-200, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115515

RESUMO

Desde 1995 hasta la fecha la asociación entre patologías derivadas los embarazos hipertensivos y las enfermedades cardiovasculares ha generado un gran volumen de potentes evidencias epidemiológicas y clínicas. Los propósitos de esta revisión son varios. Mostrar la consistencia y magnitud de la evidencia científica. Integrar los riesgos/enfermedades cardiovasculares y los problemas obstétricos a través de la disfunción endotelial. Preconizar el seguimiento postparto de la hipertensa embarazada, como una ventana de oportunidad para beneficiar la salud de las mujeres y sus hijos. Incluir la historia obstétrica como factor de riesgo de enfermedad coronaria. Proponer cuestionarios adaptables a las prácticas locales para facilitar la pronta incorporación de los índices de riesgo obstétrico y cardiovascular en dos etapas de la vida de una mujer. Ha llegado el momento para que los equipos obstétricos, cardiológicos y las pacientes jueguen un rol en la prevención de los riesgos y enfermedades cardiovasculares.


From 1995 onwards the association between hypertensive pregnancies and cardiovascular disease has generated a great volume of epidemiologic and clinical evidence. The purposes of this review are several. To demonstrate the consistence and weight of the scientific evidence. To integrate cardiovascular risks/diseases and obstetric complications through the link of endothelial dysfunction. To advocate postpartum follow-up after a hypertensive pregnancy as a window of opportunity to benefit the health of mothers and offsprings. To include the obstetrical history as a risk factor for coronary disease. To propose questionnaires adaptable to local practices to incorporate cardiovascular and obstetrical indexes in two stages of a woman's lifetime. The time has come for obstetrical teams, cardiologists and patients to play a preventive role regarding cardiovascular risks and diseases.


Assuntos
Humanos , Feminino , Gravidez , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Doenças Cardiovasculares/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco
5.
Wien Klin Wochenschr ; 132(3-4): 69-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31549230

RESUMO

Cardiovascular diseases during pregnancy are the most common causes of pregnancy-associated mortality.Vaginal delivery is the preferred mode of birth in the majority of pregnancies.It is recommended that patients with modified World Health Organization (mWHO) class IV risk are counselled against pregnancy.Patients carrying mWHO II-III, III, and class IV risks should undergo prepregnancy counselling by a multidisciplinary pregnancy heart team to determine a delivery plan and define postpartum care.Specific medications should not be principally withheld in pregnancy but the risk-benefit ratio should be carefully evaluated prior to administration.Beta blockers are recommended during and after pregnancy for congenital long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.Low molecular weight heparin is the ideal substance for prophylaxis and treatment of venous thromboembolism in pregnancy under weekly monitoring of anti-factor Xa activity.


Assuntos
Doenças Cardiovasculares , Guias de Prática Clínica como Assunto , Complicações Cardiovasculares na Gravidez , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Medição de Risco , Tromboembolia Venosa
6.
Obstet Gynecol Surv ; 74(10): 601-606, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31670832

RESUMO

Importance: Postpartum venous thromboembolism (VTE) results in significant morbidity and mortality. The practicing obstetrician-gynecologist should have a plan for management and prevention. Objective: The objective of this review is to familiarize obstetric providers with available evidence regarding postpartum VTE prevention and suggest a clinical practice guideline. Evidence Acquisition: Published literature was retrieved through a search of PubMed and relevant review articles, original research articles, systematic reviews, and practice guidelines. Results: Thromboembolic disease is one of the leading causes of maternal death in developed nations. Current evidence does not support universal postpartum VTE prophylaxis. Risk factor stratification is suggested to identify patients at high risk of VTE. Recent guidelines have recommended complex algorithms that are difficult to put into practice and have not been validated in the postpartum state. The American College of Obstetricians and Gynecologists has recommended that each institution develop a protocol to identify and treat women at high risk of postpartum VTE. Conclusions and Relevance: Obstetric providers should be familiar with available evidence and best practice regarding postpartum VTE prevention. A suggested clinical practice guideline for the prevention of postpartum VTE is provided.


Assuntos
Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Feminino , Humanos , Morte Materna/prevenção & controle , Período Pós-Parto , Guias de Prática Clínica como Assunto , Gravidez , Fatores de Risco , Tromboembolia Venosa/etiologia
7.
Clin Ter ; 170(5): e364-e367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612194

RESUMO

In the last 40 years, the number of elderly patients that require Assisted Reproductive Technologies (ART) has risen enormously, especially after heterolougus fertilization techniques have become available. In recent years, the incidence of peripartum cardiomyopathy (PPCM) has substantially grown, as a consequence of the combined effect of increased maternal age, consequent high prevalence of hypertension and metabolic syndrome (MS). That cohort of women may be exposed to a greater number of cardiac, obstetric and anesthesio-logical complications, therefore the incidence of medico-legal issues, litigation, liabilities and claims over the past years has significantly risen. Cardiovascular and hormonal changes during pregnancy can challenge even the healthiest of individuals, and in that pregnant population the risk is even greater. These patients should be monitored before the ART, during pregnancy, delivery and puerperium, to avoid heart failure, thrombotic problems, embolic complications, stroke and death. Management issues regarding pregnancy and delivery are elaborate, including anesthesia considerations. This new population of women needs an accurate cardiac risk stratification with a thorough cardiovascular history and examination, 12 lead ECG, and transthoracic echocardiogram. Therefore, a comprehensive multidisciplinary assessment and management can provide the best opportunity to improve maternal and neonatal outcomes.


Assuntos
Síndrome Metabólica/etiologia , Complicações Cardiovasculares na Gravidez/etiologia , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Síndrome Metabólica/prevenção & controle , Gravidez , Complicações Cardiovasculares na Gravidez/prevenção & controle , Gestantes , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco
8.
Cochrane Database Syst Rev ; 9: CD011192, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31523806

RESUMO

BACKGROUND: The hypertensive disorders of pregnancy include pre-eclampsia, gestational hypertension, chronic hypertension, and undefined hypertension. Pre-eclampsia is considerably more prevalent in low-income than in high-income countries. One possible explanation for this discrepancy is dietary differences, particularly calcium deficiency. Calcium supplementation in the second half of pregnancy reduces the serious consequences of pre-eclampsia, but has limited effect on the overall risk of pre-eclampsia. It is important to establish whether calcium supplementation before, and in early pregnancy (before 20 weeks' gestation) has added benefit. Such evidence could count towards justification of population-level interventions to improve dietary calcium intake, including fortification of staple foods with calcium, especially in contexts where dietary calcium intake is known to be inadequate. This is an update of a review first published in 2017. OBJECTIVES: To determine the effect of calcium supplementation, given before or early in pregnancy and for at least the first half of pregnancy, on pre-eclampsia and other hypertensive disorders, maternal morbidity and mortality, and fetal and neonatal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Trials Register (31 July 2018), PubMed (13 July 2018), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP; 31 July 2018), and reference lists of retrieved studies. SELECTION CRITERIA: Eligible studies were randomised controlled trials (RCT) of calcium supplementation, including women not yet pregnant, or women in early pregnancy. Cluster-RCTs, quasi-RCTs, and trials published as abstracts were eligible, but we did not identify any. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. They assessed the quality of the evidence for key outcomes using the GRADE approach. MAIN RESULTS: Calcium versus placeboWe included one study (1355 women), which took place across multiple hospital sites in Argentina, South Africa, and Zimbabwe. Most analyses were conducted only on 633 women from this group who were known to have conceived, or on 579 who reached 20 weeks' gestation; the trial was at moderate risk of bias due to high attrition rates pre-conception. Non-pregnant women with previous pre-eclampsia received either calcium 500 mg daily or placebo, from enrolment until 20 weeks' gestation. All participants received calcium 1.5 g daily from 20 weeks until birth.Primary outcomes: calcium supplementation commencing before conception may make little or no difference to the risk of pre-eclampsia (69/296 versus 82/283, risk ratio (RR) 0.80, 95% confidence interval (CI) 0.61 to 1.06; low-quality evidence). For pre-eclampsia or pregnancy loss or stillbirth (or both) at any gestational age, calcium may slightly reduce the risk of this composite outcome, however the 95% CI met the line of no effect (RR 0.82, 95% CI 0.66 to 1.00; low-quality evidence). Supplementation may make little or no difference to the severe maternal morbidity and mortality index (RR 0.93, 95% CI 0.68 to 1.26; low-quality evidence), pregnancy loss or stillbirth at any gestational age (RR 0.83, 95% CI 0.61 to 1,14; low-quality evidence), or caesarean section (RR 1.11, 95% CI 0.96 to 1,28; low-quality evidence).Calcium supplementation may make little or no difference to the following secondary outcomes: birthweight < 2500 g (RR 1.00, 95% CI 0.76 to 1.30; low-quality evidence), preterm birth < 37 weeks (RR 0.90, 95% CI 0.74 to 1.10), early preterm birth < 32 weeks (RR 0.79, 95% CI 0.56 to 1.12), and pregnancy loss, stillbirth or neonatal death before discharge (RR 0.82, 95% CI 0.61 to 1.10; low-quality evidence), no conception, gestational hypertension, gestational proteinuria, severe gestational hypertension, severe pre-eclampsia, severe pre-eclamptic complications index. There was no clear evidence on whether or not calcium might make a difference to perinatal death, or neonatal intensive care unit admission for > 24h, or both (RR 1.11, 95% CI 0.77 to 1.60; low-quality evidence).It is unclear what impact calcium supplementation has on Apgar score < 7 at five minutes (RR 0.43, 95% CI 0.15 to 1.21; very low-quality evidence), stillbirth, early onset pre-eclampsia, eclampsia, placental abruption, intensive care unit admission > 24 hours, maternal death, hospital stay > 7 days from birth, and pregnancy loss before 20 weeks' gestation. AUTHORS' CONCLUSIONS: The single included study suggested that calcium supplementation before and early in pregnancy may reduce the risk of women experiencing the composite outcome pre-eclampsia or pregnancy loss at any gestational age, but the results are inconclusive for all other outcomes for women and babies. Therefore, current evidence neither supports nor refutes the routine use of calcium supplementation before conception and in early pregnancy.To determine the overall benefit of calcium supplementation commenced before or in early pregnancy, the effects found in the study of calcium supplementation limited to the first half of pregnancy need to be added to the known benefits of calcium supplementation in the second half of pregnancy.Further research is needed to confirm whether initiating calcium supplementation pre- or in early pregnancy is associated with a reduction in adverse pregnancy outcomes for mother and baby. Research could also address the acceptability of the intervention to women, which was not covered by this review update.


Assuntos
Cálcio na Dieta/administração & dosagem , Hipertensão/prevenção & controle , Pré-Eclâmpsia/prevenção & controle , Complicações Cardiovasculares na Gravidez/prevenção & controle , Suplementos Nutricionais , Feminino , Humanos , Gravidez , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Circ J ; 83(11): 2257-2264, 2019 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-31462608

RESUMO

BACKGROUND: The average maternal age at delivery, and thus the associated maternal risk are increasing including in women with congenital heart disease (CHD). A comprehensive management approach is therefore required for pregnant women with CHD. The present study aimed to investigate the factors determining peripartum safety in women with CHD.Methods and Results:We retrospectively collected multicenter data for 217 pregnant women with CHD (age at delivery: 31.4±5.6 years; NYHA classifications I and II: 88.9% and 7.4%, respectively). CHD severity was classified according to the American College of Cardiology/American Heart Association guidelines as simple (n=116), moderate complexity (n=69), or great complexity (n=32). Cardiovascular (CV) events (heart failure: n=24, arrhythmia: n=9) occurred in 30 women during the peripartum period. Moderate or great complexity CHD was associated with more CV events during gestation than simple CHD. CV events occurred earlier in women with moderate or great complexity compared with simple CHD. Number of deliveries (multiparity), NYHA functional class, and severity of CHD were predictors of CV events. CONCLUSIONS: This study identified not only the severity of CHD according to the ACC/AHA and NYHA classifications, but also the number of deliveries, as important predictive factors of CV events in women with CHD. This information should be made available to women with CHD and medical personnel to promote safe deliveries.


Assuntos
Cardiopatias Congênitas/complicações , Período Periparto , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Humanos , Japão , Estudos Longitudinais , Idade Materna , Saúde Materna , Paridade , Segurança do Paciente , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
10.
BMC Cardiovasc Disord ; 19(1): 199, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419948

RESUMO

BACKGROUND: Pregnancy-associated Venous thromboembolism (VTE) is one of the most common causes of maternal morbidity and mortality in developed countries. In this study, we aimed to systematically review and critical appraisal of guidelines to compare the recommendations in pregnancy-associated VTE. METHODS: Guidelines in English between January 1, 2009 and November 31, 2018 were searched using Medline via PubMed, as well as the guidelines' website. The guidelines containing the recommendations on pregnancy-associated VTE were included. Through the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, three reviewers appraised the quality of the included guidelines. The recommendations were also summarized and compared to analyze the consistency. RESULTS: Fifteen guidelines from 13 organizations were included. Ten guidelines from nine organizations, namely, ACCP, ANZJOG, ASH, Australia, ESC, Korea, RCOG, SASTH, SOCC, were regarded as "strongly recommended for use in practice". Most of the included guidelines scored low in lower scores in domain 3 (Rigor of development) and domain 6 (Editorial independence). Recommendations on prevention are contained in ten guidelines while treatment are included in seven. The main conflicting recommendations were mainly at the anticoagulant choice for prevention on pregnant women and prevention after cesarean section. The duration of VTE treatment in pregnant women was also controversial. CONCLUSIONS: In summary, the quality of pregnancy-associated VTE guidelines varied widely, especially in Rigor of development and Editorial independence. Recommendations were inconsistent both in prevention and treatment across guidelines. Increased efforts are required to provide high-quality evidence specific to the pregnancy population. Guideline developers should also pay more attention to methodological quality.


Assuntos
Anticoagulantes/administração & dosagem , Guias de Prática Clínica como Assunto , Complicações Cardiovasculares na Gravidez/prevenção & controle , Complicações Cardiovasculares na Gravidez/terapia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/efeitos adversos , Consenso , Esquema de Medicação , Medicina Baseada em Evidências , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade
13.
Can J Cardiol ; 35(6): 761-769, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31151712

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death globally among women, and certain pregnancy complications can be the earliest indicators of increased CVD risk. Nonetheless, there is no recommendation for follow-up of cardiovascular risk factors identified through postpartum screening programs. This study describes current referral practices and clinical course from the Maternal Health Clinic in Kingston, Ontario, for women deemed at high cardiovascular risk postpartum. METHODS: We investigated the cohort of women referred from the postpartum Maternal Health Clinic to cardiology for further assessment and management, specifically examining timing and recommended interventions to reduce CVD risk. RESULTS: Women referred to cardiology differed significantly from those not referred in history of hypertensive disorders of pregnancy (P < 0.05) and demonstrated a significantly worse CVD risk profile at 6 months postpartum (P < 0.0001). Life expectancy by the cardiometabolic model for women referred was 5 years shorter (P < 0.0001). Only half of the women referred to cardiology scheduled a visit; the median time to the scheduled appointment was 12 months. Of women seen by cardiology, 60% were deemed eligible for cardiac rehabilitation. CONCLUSIONS: Although women at highest risk for CVD are being identified and referred to cardiology, the existing system is not designed for this demographic. Too many women are missing their appointments or being seen beyond 1 year postpartum. To initiate lifestyle changes and/or therapeutic interventions, we suggest that CVD prevention programming begins within 1 year of delivery. Future studies should investigate the viability of traditional cardiac rehabilitation programs among this unique population.


Assuntos
Instituições de Assistência Ambulatorial , Doenças Cardiovasculares/prevenção & controle , Programas de Rastreamento/métodos , Período Pós-Parto , Complicações Cardiovasculares na Gravidez/prevenção & controle , Encaminhamento e Consulta , Medição de Risco/métodos , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Estilo de Vida , Saúde Materna , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
J Med Case Rep ; 13(1): 115, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039808

RESUMO

BACKGROUND: Hypertension is common in pregnant women presenting with aortic coarctation or Takayasu's arteritis. Uncontrolled hypertension leads to increased adverse maternal and neonatal events. CASE PRESENTATION: A 36-year-old gravida 2, para 1 Caucasian woman presented at 9 weeks of gestation with headaches but normal blood pressure. She had a past medical history of an in vitro fertilization pregnancy complicated by preeclampsia at 27 weeks of gestation (birth weight 1900 g) and infrarenal aortic stenosis. In the current pregnancy, she received aspirin and calcium as preeclampsia prophylaxis, remained normotensive throughout pregnancy, and was delivered by elective cesarean section at 37 weeks without complications. CONCLUSIONS: This case demonstrates a significant chronic aortopathy in pregnancy with normal fetal growth and uterine blood flow through collateral supply from the internal mammary and epigastric arteries.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Aspirina/uso terapêutico , Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Cálcio/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/prevenção & controle , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Adulto , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/prevenção & controle , Cesárea , Angiografia por Tomografia Computadorizada , Feminino , Cefaleia , Humanos , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Resultado da Gravidez , Proteinúria
15.
Semin Perinatol ; 43(4): 222-228, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935752

RESUMO

Venous thromboembolism (VTE) is a leading cause of maternal death in the United Kingdom. To address this problem guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) has been developed that recommends the assessment of a woman's risk of thrombosis at specific time-points during pregnancy and postnatally at the time of delivery. The RCOG guidelines provide clinicians with a framework to inform decision-making on the use of thromboprophylaxis and are based on the premise that the higher risk a woman has for VTE, the more likely she is to benefit from prophylaxis - determining her level of risk is based on the number and characteristics of the risk factors that she has. This article will address the pathophysiology of VTE in pregnancy, evidence behind the risk factors for VTE and the use of thromboprophylactic agents. Further, it will reflect on the rationale behind the RCOG guidance.


Assuntos
Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/complicações , Tromboembolia Venosa/prevenção & controle , Adulto , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Índice de Massa Corporal , Feminino , Humanos , Período Pós-Parto , Guias de Prática Clínica como Assunto , Gravidez , Medição de Risco , Fatores de Risco , Reino Unido
16.
Semin Perinatol ; 43(4): 213-217, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935753

RESUMO

Pregnant patients are at high risk for venous thromboembolism, which accounts for 9% of maternal deaths in the United States. However, there are still a number of unanswered questions with regards to prevention, diagnosis, and treatment of this condition. This article highlights areas for future research with regards to three questions pertaining to venous thromboembolism in pregnancy: 1) how can risk stratification be improved; 2) what are the most effective means of prevention; 3) what is the role of novel oral anticoagulants in pregnancy and the postpartum period?


Assuntos
Pesquisa Biomédica/tendências , Complicações Cardiovasculares na Gravidez/prevenção & controle , Complicações Cardiovasculares na Gravidez/terapia , Tromboembolia Venosa/complicações , Animais , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Feminino , Feto/efeitos dos fármacos , Humanos , Período Pós-Parto , Gravidez , Fatores de Risco , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/terapia
17.
Semin Perinatol ; 43(4): 189-193, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935754

RESUMO

In recent years, state obstetric quality and maternal safety initiatives have led efforts to reduce maternal risk and improve maternal safety. A priority of many of these collaboratives has been to disseminate and implement safety bundles focusing on leading causes of maternal mortality including venous thromboembolism. In 2013, the Safe Motherhood Initiative (SMI), a quality improvement effort led by ACOG District II in New York State, began developing a VTE bundle reviewed available clinical evidence, practice guidelines, and protocols and assessed how hospitals with varying resources could implement standardized approaches to obstetric thromboembolism prophylaxis. This bundle was subsequently released for implementation in New York State's hospitals with support from SMI. The purpose of this review is to characterize, from the perspective of a state safety leadership collaborative, the resources that were most critical in assisting individual hospitals in (i) determining which VTE prophylaxis strategies would be adopted, and (ii) operationalizing implementation.


Assuntos
Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/complicações , Tromboembolia Venosa/prevenção & controle , Feminino , Ginecologia/métodos , Hospitalização , Humanos , Mortalidade Materna , New York/epidemiologia , Obstetrícia/métodos , Segurança do Paciente , Guias de Prática Clínica como Assunto , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Fatores de Risco , Tromboembolia Venosa/epidemiologia
18.
Semin Perinatol ; 43(4): 187-188, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30935757

RESUMO

How to best reduce maternal risk from obstetric venous thromboembolism (VTE) is a relatively controversial topic. In comparison, for other leading causes of maternal mortality and severe morbidity such as obstetric hemorrhage and hypertension, there is general agreement on recommendations. While obstetric VTE poses a unique epidemiological and public health challenge, a number of recommendations related to care improvement and patient safety can be made. This edition of Seminars in Perinatology focuses on (i) overview of clinical research and epidemiology that can serve as a basis for informed decision making regarding VTE prophylaxis strategies, (ii) VTE prophylaxis implementation from a leadership perspective, (iii) future directions for research on obstetric VTE, and (iv) critical care management of obstetric VTE.


Assuntos
Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/complicações , Tromboembolia Venosa/prevenção & controle , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Tromboembolia Venosa/terapia
19.
Semin Perinatol ; 43(4): 218-221, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30979595

RESUMO

A sustained increase in the maternal death rate in the U.S. remains one of the most challenging issues of the twenty-first century. Ten years ago, we investigated the major conditions contributing to the maternal death rate between the years 2000 and 2006. The leading causes of death in the U.S. at that time were complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage and cardiac disease. Venous thromboembolism accounted for 9% of all maternal death, and an overall pregnancy-related mortality risk of 0.9 maternal deaths per 100,000 live births. VTE was the most common preventable cause of maternal death noted during that time period. In this paper, we will review and summarize changes in obstetric health care over the last ten years implemented to prevent VTE and its related morbidity. We will then examine opportunities for hospitals and hospital systems to improve VTE prophylaxis.


Assuntos
Hospitais , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/complicações , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Feminino , Administração Hospitalar/métodos , Humanos , Mortalidade Materna , Obstetrícia/métodos , Obstetrícia/normas , Gravidez , Fatores de Risco , Tromboembolia Venosa/mortalidade
20.
Semin Perinatol ; 43(4): 229-233, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954284

RESUMO

In 2018 two documents were released from major anesthesia societies, the American Society for Regional Anesthesia (ASRA) and the Society for Obstetric Anesthesia and Perinatology (SOAP), to aid anesthesiologists in decision making regarding neuraxial procedures for obstetric patients receiving anticoagulation. For obstetrical providers seeking to provide appropriate inpatient thromboprophylaxis while also maximizing access to neuraxial anesthesia, awareness of these recommendations may be critically important. In comparison to anesthesiologists in other medical and surgical scenarios, obstetric anesthesiologists are more likely to be called upon to administer anesthesia urgently or emergently. Approximately one-third of women in the United States deliver by cesarean, and while many of these procedures will be scheduled, many others will be performed for an urgent indication where timing of delivery cannot be anticipated precisely. The purpose of this review is to summarize key clinical obstetric anesthesia management points related to anticoagulation for the obstetrician so that both VTE prophylaxis and access to neuraxial anesthesia can be optimized.


Assuntos
Anestesia Obstétrica/métodos , Anticoagulantes/uso terapêutico , Obstetrícia/métodos , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/complicações , Tromboembolia Venosa/prevenção & controle , Cesárea , Parto Obstétrico/métodos , Feminino , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Sociedades Médicas , Estados Unidos
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