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Cardiogenic Shock in Pregnancy: Data from a Large Administrative Database
Abstract Number: F-35
Abstract Type: Original Research
INTRODUCTION: Over the past few decades, severe maternal morbidity due to cardiovascular causes has increased dramatically.(1) A greater percentage of maternal deaths are due to cardiovascular conditions as compared to other causes (hemorrhage, thromboembolic events, hypertensive disorders, sepsis) than previously noted. (2,3) The objective of this study was to determine the incidence and mortality of maternal cardiogenic shock (CS) and identify maternal risk factors.
METHODS: We obtained weighted estimates of the number of hospitalizations for deliveries complicated by CS (ICD-9 codes) obtained through the Nationwide Inpatient Sample (NIS) from 2004 to 2011. NIS is a federal database, which contains discharge data from approximately 20% of all annual US hospital admissions and is weighted to obtain national estimates for all US hospital admissions. The results are reported as proportions with 95% confidence intervals.
RESULTS: Among 29,220,488 deliveries, 303 were complicated with CS. Parturients with CS experienced a significantly higher mortality (23.9%) compared to healthy parturients (0.01%). The severity of the CS was manifested by the significant proportion of patients who received mechanical ventilation, an intra-aortic balloon pump, and/or extracorporeal membrane oxygenation. Maternal comorbidities most significantly associated with the development of CS were: congestive heart failure, peripartum cardiomyopathy, preeclampsia, amniotic fluid embolism, chronic hypertension, valvular disease, and acute myocardial infarction (See Table). Parturients with the above comorbidities who developed CS had an adjusted odds ratio of 334.40 (CI 109.62-1019.70) for death as compared to parturients with the same comorbidities who did not develop CS. The odds ratio was adjusted to incorporate the effects of hospital location, hospital size, obesity, race, and payer mix.
CONCLUSION: Maternal CS is associated with significant mortality. Based on our results, the most important contributory factors are: congestive heart failure, peripartum cardiomyopathy, preeclampsia, amniotic fluid embolism, chronic hypertension, valvular disease, and acute myocardial infarction. Identifying those patients most at risk for developing CS may allow us to modify care in a way that limits its morbidity and mortality.
1 Callaghan. Mat Morbidity. Obstet Gynecol. 2012.
2 Berg. Preg Related Mortality. ACOG 2010.
3 Creanga. Preg Related Mortality. Obstet Gynecol. 2015.