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///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Severe heart disease (HD) complicating pregnancy does not preclude a favorable pregnancy outcome: 15 years experience in a single center

Abstract Number: 165
Abstract Type: Original Research

Alexander Ioscovich MD1 ; Rachel Cohen MD2; Shunit Armon MD3; Michael S Schimmel MD4; Arnon Samueloff MD5; Sorina Grisaru-Granovsky MD6

Aim: To define the maternal and neonatal outcome of high risk HD disease in pregnancy.

Study Design: Observational study (1994-2007) of pregnant HD patients > 22 weeks gestation in a tertiary referral center. HD degree defined by either the NYHA or Clark scores. Group1 (low risk) identified as NYHA 1&2 or Clark 1; Group2 ( high risk) as NYHA 3&4 or Clark 3.

All patients were managed under a strict comprehensive institutional protocol: midtrimester hospitalization for cardiology, anesthesia and pediatric consult; follow up antenatal care at specialized clinics. Additional hospitalization was according to medical or obstetric indications. Birth plan was determined in all cases by obstetrical indications alone.

Statistics: One way ANOVA ; t-test, Pearson, λ2and Fisher's exact for association.

Results: 175 women with pregnancies complicated by maternal HD. were compliant with protocol. HD diagnostic categories: rheumatic 64(36.5%), congenital 44 (25%), Marfan 7(4%), coronary 7(4%), other cardiomyopathies 53 (30%), Group 1 (low risk) = 119 (68%); Group2 ( high risk)=55(32%). No significant difference among the study groups comparing diagnoses, parity, maternal age gestational age at delivery, mode of delivery, mean birth weight and 5'Apgar. The overall cesarean rate for Group 1 31(26%) vs Group 2 16(29%) (p=0.71): elective 23 (19%) vs 14 (25.5%), emergency 8(6.7%) vs 2 (3.6%) p=0.5. Birth occurred during working hours in 42(35.3%) vs 18 (32.7%) p=0.8.

The study groups differed significantly in mean hospital time ( 53.9 vs 1118, p=0.000; ) and ICCU days (0.21.3 vs 0.82.2, p=0.02). Analysis per diagnosis noted that mothers with Marfan syndrome and coronary HD in both study groups as compared to other diagnostic categories had significant lower parity, and increased preterm delivery rate (mean 365.5 weeks), cesarean rate (57.1% and 28.6%) and hospital stay ( 17 28 and 6 4.5). The maternal and neonatal mortality were zero in both study groups.

Conclusion: High risk HD patients in a selected population of motivated women, under optimal comprehensive medical care do not preclude a favorable perinatal outcome. We suggest special attention be afforded the mother with Marfan syndrome and coronary HD as may require planned delivery due to the non predictive nature of their cardiac complications.

SOAP 2009