Abstract 12699: Impact of Mode of Delivery on Maternal and Fetal Outcomes in Pregnant Patients With Heart Failure or Pulmonary Hypertension

Abstract

Introduction: Despite the existing guidelines, data on maternal, fetal, and obstetric outcomes associated with various modes of delivery in pregnant patients with heart failure (HF) or severe pulmonary hypertension (pHTN) is limited. Methods: This retrospective population based cohort study used Nationwide Readmission Database to identify all hospitalized pregnant patients who were primarily admitted for vaginal or cesarean delivery from 2011 to 2019. Pregnant patients with HF or pHTN were identified. Primary outcomes were inhospital maternal and fetal mortality. Result: 23,359 hospitalized pregnant patients with HF or pHTN were identified. Cesarean deliveries were performed more than vaginal deliveries (66.2% vs. 33.8%). Patients undergoing cesarean delivery had lower odds of fetal mortality [OR: 0.18 (0.07-0.45), p<0.001] and postpartum hemorrhage than vaginal delivery. However, the odds of in-hospital maternal mortality [OR: 2.0 (1.07-3.77), p=0.03], ACS, and puerperal sepsis were higher in cesarean group than in vaginal delivery group. There were no differences in the odds of in-hospital stroke and DVT/PE between two groups. We found that 167 pregnant women would have to undergo cesarean delivery to have one inhospital maternal mortality (NNH=167), and 164 pregnant women would have to undergo cesarean delivery to prevent one fetal mortality (NNT=164). There were increased odds of all-cause readmissions within 6 months in patients who had cesarean delivery compared with those who had vaginal deliveries. There was no difference in risk of acute exacerbation of HF, readmission mortality, ACS, stroke, and DVT/PE between two groups at 6 months. Conclusion: In this retrospective multicentric cohort study, cesarean delivery was associated with lower fetal mortality but higher inhospital maternal mortality. Thus, unique features of each patient case should be considered via a multidisciplinary discussion before determining a preferred delivery method.