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INCIDENCE and DESCRIPTIVE ANALYSIS OF CONGENITAL HEART DISEASE IN PARTURIENTS - ANESTHETIC and OBSTETRIC OUTCOMES
Abstract Number: T-35
Abstract Type: Original Research
Objective: Congenital heart disease (CHD) is a major cause of heart disease in pregnant women in the United States (1). Cardiovascular changes of pregnancy place these women at risk for maternal and fetal complications during labor and delivery. In addition, cardiac disease is a leading reason for intensive care unit (ICU) admission (2) and maternal death (3). This study describes peripartum anesthetic management, complications, and obstetric outcomes in a cohort of women with CHD at the University of Colorado Hospital, a tertiary referral center.
Study Design: Patients with CHD who delivered between October 2005 and December 2009, were identified from a large perinatal database (n=13,109) based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis (SBE) prophylaxis given during labor (n=600). From this population, each parturient’s medical record underwent screening for CHD based on echocardiogram results. The most severe cardiac defect was prioritized in women with multiple defects. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was also performed.
Results: 343 (2.6%) women had cardiac disease including 75 (0.6% of 13,109) with CHD. The mean age of women with CHD was 26.4 ± 6.2 years. The majority were non-Hispanic white (59%), Hispanic white (28%), and nulliparous (55%). Most were non-smokers (92%) and 34% were overweight (16%) or obese (18%). Table 1 describes the subsets of CHD from this cohort as well as anesthetic, obstetric, and neonatal outcomes. No women classified higher than New York Heart Association (NYHA) classification of 3 for heart failure. There were 2 maternal ICU admissions solely for prophylactic cardiac monitoring and no cases of maternal mortality. There were 17 neonatal ICU admissions among the CHD group.
Conclusions: Cesarean delivery was more common in patients with CHD (31%) compared to our institutions’ overall rate (27%). Neonatal ICU admissions were also more common, 23% compared to an overall rate of 15%. Most patients received regional anesthesia for cesarean delivery and vaginal labor. Although most had a prolonged hospital stay, maternal ICU admissions were rare. Pregnant women with CHD may undergo labor and delivery with few complications but have prolonged hospital stays.
1. Siu SC, Colman JM. Heart 2001;85:710
2. Small MJ, James AH, Kershaw R, et al. Obstet Gynecol 2012; 119:250
3. Malhotra S, Yentis SM. IJOA 2006;15:223