Maternal Arrhythmia and Perinatal Outcomes

Abstract

INTRODUCTION: Maternal cardiac diseases can be severely compromised in the setting of arrhythmias. We compared perinatal outcomes among women with a cardiac arrhythmia with women with other types of cardiac disease. METHODS: This is a retrospective cohort study of pregnant women with cardiac disease who delivered from 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared with those with other types of maternal cardiac disease (congenital, structural, or cardiomyopathy). RESULTS: A cohort of 143 women was identified; 37 (26%) had a diagnosis of an arrhythmia. Compared with women without arrhythmias, those with an arrhythmia were more likely to have a spontaneous vaginal delivery (62% compared with 43%, P<.05) and required fewer operative vaginal births (11% compared with 26%, P=.05). Pregnancies were more likely to be complicated by intrauterine growth restriction (IUGR) (16% compared with 5%, P<.05) and placental abruption (5% compared with 0%, P<.05). The risk of IUGR remained increased in multivariable model controlling for confounding (adjusted odds ratio 6.9, 95% confidence interval 1.6–30.4, P=.01). There were no differences in rates of other maternal complications including gestational diabetes, postpartum hemorrhage, chorioamnionitis, or intensive care unit admission. Neonatal outcomes including gestational age at delivery, birth weight, 5-minute Apgar, umbilical artery pH less than 7, and neonatal intensive care unit admission were not different. CONCLUSIONS: Patients with arrhythmias were more likely to have a successful vaginal delivery compared with those other maternal cardiac diseases. However, the pregnancy had an increased risk for IUGR and placental abruption. The rates of adverse neonatal outcomes were similar between the groups.