Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease

• Published in: Revista clínica espanõla (English edition) 2024-06, Vol.224 (6), p.337-345
• Main Authors: Guzmán-Delgado, N.E., Velázquez-Sotelo, C.E., Fernández-Gómez, M.J., González-Barrera, L.G., Muñiz-García, A., Sánchez-Sotelo, V.M., Carranza-Rosales, P., Hernández-Juárez, A., Morán-Martínez, J., Martínez-Gaytan, V.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cardiopatía congénita/adquirida; Cardiovascular/obstetric adverse event; Congenital/acquired heart disease; Cross-Sectional Studies; Embarazo; Evento cardiovascular/obstétrico adverso; Female; Heart Diseases; Humans; Infant, Newborn; Maternal death; Muerte materna; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - epidemiology; Puerperal Disorders - epidemiology; Puerperal Disorders - etiology; Puerperio; Puerperium; Pulmonary Edema - epidemiology; Pulmonary Edema - etiology; Retrospective Studies; Young Adult
• ISSN: 2254-8874; 2254-8874
• DOI: 10.1016/j.rceng.2024.04.016

cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. Cross-sectional and retrospective study, which included the 2017–2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. 112 patients with a median age of 28 years (range 15−44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5−10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6−194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3−84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5−616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2–16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4−68, p = 0.021). severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital. los cambios cardiovasculares del embarazo conllevan mayor riesgo en cardiópatas. El objetivo fue analizar los efectos adversos cardiovasculares, obstétricos y perinatales asociados a cardiopatía congénita y adquirida durante el embarazo y puerperio. Estudio transversal y retrospectivo, que incluyó el registro de 2017–2023 de pacientes embarazadas o puérperas hospitalizadas con diagnóstico de cardiopatía congénita o adquirida. Se compararon los eventos adversos (falla cardiaca, evento vascular cerebral (EVC), edema agudo pulmonar, muerte materna, hemorragia obstétrica, prematuridad y muerte perinatal) con las variables clínicas y el tratamiento implementado. Se incluyeron 112 pacientes con medi