The REBECGA brazilian registry of pregnancy and heart disease: rationale and design

BACKGROUND: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. OBJECTIVES: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country's macro-regions. METHODS: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees. RESULTS: Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy. CONCLUSIONS: REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

Cardiopatias congênitas e gravidez / Congenital heart disease and pregnancy

Nas últimas décadas, os avanços no tratamento das doenças cardíacas favoreceram o aumento expressivo da sobrevida de mulheres portadoras de cardiopatias congênitas, possibilitando o alcance da idade reprodutiva e permitindo o desenvolvimento da gravidez. Contudo, as cardiopatias congênitas ainda estão associadas a significativa morbidade e mortalidade materna no ciclo gravídico-puerperal. As complicações cardíacas que ocorreram durante a gravidez resultam da má adaptação ao aumento do débito cardíaco, da queda da resistência periférica, e da presença e do grau de cianose. A correção cirúrgica ou percutânea prévia à gestação proporciona melhora significativa no prognóstico materno-fetal, reduzindo seu risco à semelhança de mulheres saudáveis. Dentre os fatores determinantes do prognóstico materno destacam-se classe funcional da New York Heart Association (NYHA), cianose, hipertensão arterial pulmonar, disfunção ventricular e lesões cardíacas residuais pós-intervenção. No que diz respeito às complicações fetais, destacam-se restrições de crescimento intrauterino...