Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies.
JACC Heart Fail
; 11(12): 1678-1689, 2023 12.
Article
de En
| MEDLINE
| ID: mdl-37943228
ABSTRACT
BACKGROUND:
Women with cardiomyopathies are at risk for pregnancy complications. The optimal mode of delivery in these patients is guided by expert opinion and limited small studies.OBJECTIVES:
The objective of this study is to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization and readmissions among patients with cardiomyopathies.METHODS:
The Premier inpatient administrative database was used to conduct a retrospective cohort study of pregnant patients with a diagnosis of a cardiomyopathy. Utilizing a target trial emulation strategy, the primary analysis compared outcomes among patients exposed to intended vaginal delivery vs intended cesarean delivery (intention to treat). A secondary analysis compared outcomes among patients who delivered vaginally vs by cesarean (as-treated). Outcomes examined were nontransfusion severe maternal morbidity during the delivery hospitalization, blood transfusion, and readmission.RESULTS:
The cohort consisted of 2,921 deliveries. In the primary analysis (intention to treat), there was no difference in nontransfusion morbidity (adjusted OR [aOR] 1.17; 95% CI 0.91-1.51), blood transfusion (aOR 1.27; 95% CI 0.81-1.98), or readmission (aOR 1.03; 95% CI 0.73-1.44) between intended vaginal delivery and intended cesarean delivery. In the as-treated analysis, cesarean delivery was associated with a 2-fold higher risk of nontransfusion morbidity (aOR 2.44; 95% CI 1.85-3.22) and blood transfusion (aOR 2.26; 95% CI 1.34-3.81) when compared with vaginal delivery.CONCLUSIONS:
In patients with cardiomyopathies, a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned cesarean delivery.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Défaillance cardiaque
/
Cardiomyopathies
Limites:
Female
/
Humans
/
Pregnancy
Langue:
En
Journal:
JACC Heart Fail
Année:
2023
Type de document:
Article