Cardiac Disease In Pregnancy Research Articles

Outcome reporting in cardio-obstetrics studies: A systematic review

BackgroundAlthough considerable variation in the reporting and definition of outcomes in cardio-obstetric studies is known, the extent of this variation has not been documented. The primary objective of this systematic review was to highlight this variation and inform the development of a Core Outcome Set for studies on Cardiac disease in Pregnancy (COSCarP). MethodsMedline, Embase, Web of Science and Cochrane Central databases were searched from 1980 to 2018 to identify all English-language publications on pregnancy and heart disease. Title/abstract screening and data extraction which included details on the study, patient population, and all reported outcomes, was performed in duplicate by two reviewers. As the aim of the review was to identify variation in outcome reporting, risk-of-bias assessment was not performed. The study protocol was registered on PROSPERO (CRD42016038218). ResultsThe final analysis included 422 cardio-obstetric studies. Maternal mortality or survival were reported in 232/422 studies, with inconsistency in terms of cause of death [all-cause (n=65), cardiac (n=55) or obstetric (n=10)] or timeframe (ranging from in-hospital mortality (n=11) to mortality 5 years following pregnancy). In 95/232 studies (41%), the cause and timeframe were not specified. Similar inconsistencies in reporting and definitions were noted for outcomes such as heart failure (n=298), perinatal loss (n=296), fetal growth (n=221), bleeding (n=205), arrhythmias (n=202), preterm birth (n=191), thromboembolism (n=153) and hypertensive disorders (n=122). Functioning / life-impact and adverse effects of treatment were sparingly reported in cardio-obstetric studies. ConclusionsThis systematic review hopes to create awareness among cardio-obstetric teams about the inconsistencies in reporting and defining outcomes which makes it difficult to compare studies and perform meta-analyses. COSCarP which is being developed through international consensus between patients and care-providers will provide cardio-obstetrics teams with a minimal set of outcomes to be reported in future cardio-obstetric studies.

Abstract P415: The Current Cardiac Disease in Pregnancy -II Risk Score as a Predictor of Pregnancy Morbidity is Not Affected by Maternal Obesity

Cardiovascular disease (CVD) is the most common cause of death in adults over 40 years of age. CVD remains a common cause of death in pregnancy and within the first-year post-partum, and Black women have higher cardiovascular risk during pregnancy than White women. There are several established mortality and morbidity prediction models for maternal cardiac complications including the Cardiac Disease in Pregnancy (CARPREG) risk score. CARPREG-II is the newest risk score which uses ten criteria to predict maternal cardiac complications. However, the only study to validate the CARPREG-II risk score had a large sample size with only 15% of patients with obesity (body mass index (BMI) >30 kg/m2). Obesity and increased obesity class are known risks factors for pregnancy related morbidity and mortality. Thus, the validity of CARPREG-II risk score as a predictor of cardiovascular risks and pregnancy outcomes in women with cardiac disease and obesity remains unknown. Therefore, the goals of our study were to assess the validity of the CARPREG-II score in Black and White women as a predictor of risk for cardiovascular morbidity and mortality in obese pregnant women and determine if obesity influences CARPREG-II score and pregnancy morbidity and mortality. For this study, we completed an IRB-approved retrospective chart review of 232 pregnant adult Black and White women who received care at the University of Mississippi Medical Center (UMMC) from January 2013 - 2020. We completed a CARPREG-II risk score and compared morbidity in patients with normal BMI (18-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class I (30-34.9 kg/m2), obesity class II (35-39.9 kg/m2), and obesity class III (>40 kg/m2). By race, the majority of White women were categorized as overweight; whereas the majority of Black women were categorized as obesity class II or III (p=0.0016). Although frequency of BMI category differed by race, CARPREG-II score did not differ as BMI increased in Black or White women, and obesity class did not influence CARPREG-II risk score. Our data indicate that Black women were more likely to have increased obesity, but obesity class did not influence CARPREG-II score. The lack of association between obesity class and CARPREG-II risk score indicate that the current CARPREG-II assessment is not an appropriate risk assessment tool for pregnant obese women and additional studies/tools are warranted to determine cardiovascular risks in pregnant obese women.

Preconception counselling in women of reproductive age attending cardiology clinics in Scotland

BackgroundGuidelines for the management of cardiovascular disease (CVD) recommend preconception risk stratification and counselling in all women of childbearing age. We assessed the provision of preconception counselling (PCC) among women...

Cardiac evaluation in pregnant patients with dyspnea and palpitations

BackgroundSymptoms of underlying cardiac disease in pregnancy can often be mistaken for common complaints due to normal physiologic changes in pregnancy. Echocardiographic evaluation of patients with symptoms of palpitations and dyspnea can detect structural changes and identify high-risk features. ObjectiveThe study's objective was to examine transthoracic echocardiograms (TTEs) of perinatal individuals completed for palpitations or dyspnea to determine the frequency of identifying structural changes. Study DesignWe performed a retrospective cohort study of all perinatal individuals with a TTE at a single academic center between October 1, 2017, and May 1, 2022. The indication for the echocardiogram, demographics, and clinical characteristics were recorded. TTEs with any abnormal findings noted in the TTE report were reviewed and categorized into findings of congenital heart disease, valvular disease, pericardial effusion, evidence of ischemia/wall motion abnormalities, abnormal diastolic/systolic function, and other. ResultsOf our sample of 539 TTEs completed on 478 different individuals who were pregnant or in the 12-week post-partum period, 96 (17.8%) had an indication of palpitations and 32 (5.9%) were listed dyspnea as the indication. Abnormal findings were seen in 21.9% of patients with palpitations and in 34.4% of those with dyspnea. In the patients with palpitations who had abnormal findings, 33.3% had congenital heart disease, 33.3% had mild valvular disease including mitral valve prolapse, 19.0% had a pericardial effusion, and 14.3% had evidence of ischemia/wall motion defects. Abnormal TTE findings in the dyspnea cohort included ischemia/wall motion defects (27.3%), mild valvular disease or mitral valve prolapse (36.4%), and abnormal systolic/diastolic function (36.4%). ConclusionMany of the TTEs completed for patients with dyspnea or palpitations identified no structural abnormalities, however, in about one in three to one in four patients underlying structural heart disease was identified. While some of these abnormalities were unlikely to change delivery plans like mild valvular disease or small effusions, others such as ischemia, congenital abnormalities, and abnormal systolic/diastolic function were likely to have implications for pregnancy and post-partum management.

Prolonged Labor and Adverse Cardiac Outcomes in Pregnant Patients With Congenital Heart Disease

(Am J Obstet Gynecol. 2023;228(6):728.e1–728.e8) Congenital heart disease (CHD) is one of the most common types of birth defects and affects 8 to 9 per 1000 births. Many patients who have it are diagnosed in infancy, but some are not diagnosed until later in life. The number of patients with CHD who reach childbearing years has increased substantially. Pregnancy can pose difficult challenges, especially in labor and delivery. The physiologic changes that occur during delivery, including increased cardiac demand, rapid changes in intravascular volume, and blood loss, result in significant risk for patients with CHD. The European Registry of Pregnancy and Cardiac disease and the Cardiac Disease in Pregnancy 2 studies have demonstrated that the immediate postpartum period is the highest risk time for heart failure.

Cardiogenic Shock and Utilization of Mechanical Circulatory Support in Pregnancy.

Maternal mortality rates are rising in the United States, a trend which is in contrast to that seen in other high-income nations. Cardiovascular disease and hypertensive disorders of pregnancy are consistently the leading causes of maternal mortality both in the United States and globally, accounting for about one-quarter to one-third of maternal and peripartum deaths. A large proportion of cardiovascular morbidity and mortality stems from acquired disease in the context of cardiovascular risk factors, which include obesity, pre-existing diabetes and hypertension, and inequities in care from maternal care deserts and structural racism. Patients may also become pregnant with preexisting structural heart disease, or acquire disease throughout pregnancy (ex: spontaneous coronary artery dissection, peripartum cardiomyopathy), and be at higher risk of pregnancy-related cardiovascular complications. While risk-stratification tools including the modified World Health Organization (mWHO) classification, Cardiac Disease in Pregnancy (CARPREG II) and Zwangerschap bij Aangeboren HARtAfwijking/Pregnancy in Women with Congenital Heart Disease (ZAHARA) have been designed to help physicians identify patients at increased risk for adverse pregnancy outcomes and who may therefore benefit from referral to a tertiary care center, the limitation of these scores is their predominant focus on patients with known preexisting heart disease. As such, identifying patients at risk for pregnancy complications presents a significant challenge, and it is often patients with high-risk cardiovascular substrates prior to or during pregnancy who are at a highest risk for adverse pregnancy outcomes including cardiogenic shock.

Foetomaternal Outcomes in Pregnant Women with Corrected vs Non corrected Heart Disease: A Cross-sectional Analysis at a Tertiary Care Institute of Eastern India

Introduction: Cardiac disease in pregnancy remains a major concern, particularly in developing countries like India. Pregnancy in women with heart disease increases the risk of maternal and foetal complications. Approximately 1% to 4% of pregnant women have concomitant cardiac disease. Aim: To examine the foetomaternal outcomes of pregnant women in the corrected vs. non corrected heart disease groups. Materials and Methods: This was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology at IPGME&R, Kolkata, West Bengal, India, from February 2020 to July 2021. A total of 50 pregnant women were included in the present study, with 25 in the corrected heart disease group and 25 in the non corrected heart disease group. Foetomaternal outcomes, including intrapartum complications, maternal intensive care unit admission, mode of delivery, and foetal complications, were observed. Comparative analyses were conducted using the Student’s t-test and Chi-square test. The p-values <0.05 was considered statistically significant. Results: Data from the present study showed that out of a total of 50 pregnant women with heart disease, the majority (60%) were young (≤25 years). Approximately 48% of women were in their second pregnancy. The most common cardiac lesion in the corrected group was closure of Atrial Septal Defect (ASD) in 8 (16%) cases, while in the non corrected group, the most common was mitral regurgitation in 11 (22%) cases. In the corrected heart disease group, 15 (30%) had a caesarean section and 10 (20%) delivered vaginally, whereas in the non corrected group, 17 (34%) had a caesarean section and 8 (16%) delivered vaginally. Adverse cardiac events occurred in 2 (4%) of the corrected group, whereas 11 (22%) were observed in the non corrected group (p-value=0.0088, significant). Preterm birth and low birth weight babies were more common in the non corrected heart disease group (p-value=0.0449, significant). Conclusion: The study concludes that most women with cardiac disease are young. Compared to the Corrected Group of Heart Disease (CGHD), the non corrected group of pregnant women are more likely to experience severe cardiac complications and require admission to the intensive care unit. The foetomaternal outcome is better in the corrected group. Successful management of pregnant women with heart disease requires a comprehensive multidisciplinary approach to optimise foetomaternal outcomes.

Pregnancy outcomes of women with cardiac disease.

To determine and predict the maternal and neonatal outcomes of pregnancies occurring in patients with cardiac disease. This retrospective review included 147 pregnancies identified from antenatal, delivery, and nursery records. Information concerning the nature and severity of the pre-existing cardiac disease, comorbidities, risk scores, obstetric or cardiac complications, and pregnancy outcomes were collected. The data were analyzed using SPSS Windows version 22. In all, 111 (73.5%) of the cohort had acquired heart disease and 4 (2.7%) of patients belonged to WHO class IV, in which pregnancy is not recommended. Additionally, 12 (8.1%) were categorized as being at significant risk of having a cardiac complication. The proportion of patients that had maternal and perinatal mortality was 6 (4.0%) and 7 (4.8%), respectively. The WHO and CARPREG scoring systems were reliably able to predict cardiac events (P < 0.01). Mothers who received preconception counseling had significantly fewer occurrences of cardiac and obstetric events than those who did not. Cardiac disease in pregnancy in women managed at our center was most often an acquired disease. The baseline risk assessment scores accurately predicted the likelihood of adverse cardiac outcomes.

Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum

ABSTRACT Purpose Patient self-advocacy is valued and promoted; however, it may not be readily accessible to all. This analysis examines the experiences of women in Australia who had cardiac disease in pregnancy or the first year postpartum through the lenses of self-advocacy and gender, specifically seeking to elaborate on the contexts, impacts, barriers, and women’s responses to the barriers to self-advocacy. Method A qualitative study design was used. Twenty-five women participated in semi-structured in-depth interviews. Data were analysed using thematic analysis. Results Analysis of findings generated the following themes: 1) Silent dream scream, 2) Easier said than done, 3) Crazy-making, and 4) Concentric circles of advocacy. Regardless of women’s personal attributes, knowledge and experience, self-advocating for their health was complex and difficult and had negative cardiac and psychological outcomes. Conclusion While the women encountered significant barriers to self-advocating, they were resilient and ultimately developed strategies to be heard and to advocate on their own behalf and that of other women. Findings can be used to identify ways to support women to self-advocate and to provide adequately resourced and culturally safe environments to enable healthcare professionals to provide person-centred care.

Focused cardiac ultrasound in pregnancy.

Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.

Cardiac disease and risk of hypertensive disorders of pregnancy

Cardiovascular disease affects 1-4% of US pregnancies and is the leading cause of pregnancy related deaths. There are limited data on rates of hypertensive disorders of pregnancy (HDP) in this population. ACOG and USPSTF guidelines for aspirin (ASA) use for reduction of preeclampsia (PEC) do not include cardiac disease in the high or moderate risk categories. Our objective was to determine if cardiovascular disease is a risk factor for developing HDP. This was a retrospective cohort study of pregnancies complicated by maternal cardiac disease at a single academic center between 2018 and 2022. Patients with cardiac disease (congenital or acquired) who delivered after 20 weeks were included. For patients with multiple pregnancies during the timeframe, only the first pregnancy was included. Patient demographics and pregnancy outcomes were recorded. The primary outcome was development of HDP. Secondary outcomes were correlation of HDP with presence of one high or two moderate risk factors based on ACOG guidelines for ASA use and severity of cardiac disease based on modified World Health Organization (mWHO) risk class. 115 patients were included. Demographic and outcomes are shown in Table 1. 18 (15.7%) patients developed HDP and 71 patients (61.7%) were on ASA. Among the 18 patients with HDP, 55% developed PEC with severe features and 44% developed PEC post-partum. HDP was associated with multiple gestations (p< 0.01), age (p=0.04) and the combination of one high risk or two moderate risk factors for PEC (p=0.03). mWHO class was not associated with development of HDP (p=0.86). It has not been established if cardiac disease in pregnancy is an independent risk factor for developing PEC. Our study reveals high rates of HDP in this cohort (15.7% in our population compared to CDC rate of 4% of US pregnancies), even in the setting of ASA use and regardless of mWHO risk class. While more research is needed, based on our data it would be reasonable to offer patients with cardiac disease ASA for prevention of PEC.

Maternal heart rate collection pre- and post-cardiac screening guideline implementation in an outpatient obstetrics office

The California Maternal Quality Care Collaborative (CMQCC) proposed an algorithm to reduce maternal mortality by screening for cardiac disease in pregnancy, including use of maternal heart rates. The effect of this guideline was assessed at an outpatient obstetrics office by studying rates of heart rate screening before and after implementation. This study reviewed 100 return in-person prenatal visits monthly from January 2019 to November 2021. Maternal heart rate, demographics, and presence of chronic hypertension or cardiac disease were noted. Rates of heart rate collection were compared pre- and post-guideline implementation. Per the CMQCC guideline, a resting heart rate of ≥ 110 bpm was deemed high enough to warrant further evaluation. This retrospective cohort included 3,478 visits (100 visits per month, fewer visits in April and May 2020 due to COVID19 pandemic). Several visits (n=382, 11%) were to patients with chronic hypertension and 159 (4.6%) had underlying cardiac disease. Overall, 1798 (51.7%) visits recorded a maternal heart rate, while 1680 (48.3%) did not. More visits had heart rates recorded post- than pre-guideline (67.6% versus 21.4% of visits, respectively; p < 0.001). Maternal heart rates ≥ 110 bpm were recorded at 130 visits (3.7%). Pre-guideline, 29.5% of patients with heart disease and/or chronic hypertension had heart rate recorded compared to 20.1% of patients without these conditions (p=0.005). Post-guideline, patients with heart disease and/or chronic hypertension were more likely to have heart rate recorded compared to those without these conditions (78.8% versus 65.8%, p < 0.001). Elevated heart rates ≥ 110 were recorded at 34 of 308 (11.0%) visits to patients with known hypertension and/or cardiac disease, compared to 96 out of 1490 (6.4%) to patients without these diagnoses (p=0.005). Maternal heart rate screening significantly increased after guideline implementation. Patients with underlying cardiac disease and/or chronic hypertension were nearly twice as likely to have a heart rate ≥ 110 bpm when heart rate was assessed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Analysis Effects of Pender Health Promotion Model Education on Health Behaviors and Maternal and Infant of Cardiac Disease in Pregnancy

ABSTRACT Pregnancy with cardiac disease includes pregnancy in women with a history of heart disease and cardiac disease during pregnancy. Therefore, we aim to investigate the effect of Pender health promotion model (HPM) on the health behaviors and maternal and fetal outcomes in pregnant patients with cardiac disease. 80 pregnant women with cardiac disease were enrolled in the study from January 2016 to December 2017. 40 patients who received HPM health education were selected as treatment group by convenient sampling method. 40 patients were selected to receive routine health education. After 12 weeks of education, the awareness of health knowledge before and after education, health behavior compliance, level of pre-partum cardiac function, and maternal and fetal outcomes were compared between the two groups. After education, the knowledge rate in observation group was higher than that in control group (P < 0.01, P < 0.05); the compliance of health behavior in observation group was higher than that in control group (P < 0.01, P < 0.05); before delivery, the rate of cardiac function(I+II) in observation group was 67.50% and significantly lower than 42.50% in control group (P < 0.05); after education, the incidence rate of severe heart failure, cesarean delivery, premature delivery and full-term infants with low body mass in observation group was significantly lower than that in control group (P < 0.05). The Pender health promotion model can improve the knowledge of health knowledge and compliance of health behaviors of pregnancy with cardiac disease effectively, and it can help reduce heart burden and improve maternal and child outcomes.

Quality of life and mental health of women who had cardiac disease in pregnancy and postpartum

PurposeCardiac disease is a leading cause of maternal morbidity and mortality yet there is limited research on women’s experiences and quality of life (QoL) outcomes. The aim of this study is to explore the general and health-related QoL (HRQoL) and mental health outcomes for women who have experienced cardiac disease in pregnancy and the first 12 months postpartum (CDPP).MethodsThis exploratory descriptive study recruited 43 women with acquired, genetic and congenital CDPP. Patient reported outcomes measures (PROMs) used were: WHOQoL-Bref, a Kansas City Cardiac Questionnaire (KCCQ), the Depression, Anxiety and Stress Scales-21 (DASS-21), the Cardiac Anxiety Questionnaire (CAQ) plus newly developed questions.ResultsWomen reported low health satisfaction (51.7/100), physical health (55.2/100) and low HRQoL (63.1/100). Women had clinically significant scores for depression (24%), anxiety (22%) and stress (19.5%) (DASS-21) and 44.5% scored at least moderate anxiety on the CAQ. Most women (83.7%) were advised to avoid pregnancy which 88.9% found “upsetting” to “devastating”; 10.0% were offered counselling. Most women were concerned about reduced longevity (88.1%), offspring developing a cardiac condition (73.8%), and the limitations on enjoyment of life (57.1%). Women missed medical appointments due to cost (25.03%) and difficulty arranging childcare (45.5%).ConclusionThe majority of women reported inadequate information and counselling support, with women with CDPP having sustained impaired QoL and mental health outcomes. The new and modified questions relating to mothering and children reflected the primacy of mothering to women’s identity and needs.

Trending Cardiac Biomarkers During Pregnancy in Women With Cardiovascular Disease.

Clinical utility of cardiac biomarker testing during pregnancy in women with preexisting cardiac disease is not well known. We studied the levels and temporal trends of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and hs-cTnI (high-sensitivity cardiac troponin I) throughout pregnancy in women with preexisting cardiac disease and sought to assess the association between NT-proBNP and hs-cTnI and pregnancy outcomes. Three hundred seven pregnant women with preexisting cardiac disease were prospectively recruited. Mixed-effects linear regression analysis was used to compare the NT-proBNP and hs-cTnI levels between time periods and subgroups. Logistic regression analysis adjusted for maternal age and CARPREG II (Cardiac Disease in Pregnancy) risk score assessed the association between NT-proBNP levels and adverse events. Geometric mean NT-proBNP (95% CI) was stable through pregnancy with a transient significant increase with labor and delivery (101.4 pg/mL [87.1-118.1], 90.2 pg/mL [78.5-103.6], 153.6 pg/mL [126.8-186.1], and 112.2 pg/mL [94.2-133.7] for first/second trimester, third trimester, labor/delivery and postpartum, respectively). We observed a statistically significant difference in the NT-proBNP between women with preserved versus decreased systemic ventricular function, structurally normal versus abnormal heart, modified World Health Organization class 1, 2 versus modified World Health Organization class 3, 4 and no congenital heart disease versus congenital heart disease. Compared to those without events, median (interquartile range) NT-proBNP levels were significantly higher in those who had heart failure (204 pg/mL [51-450] versus 55 pg/mL [31-97]; P=0.001) and preeclampsia (98 pg/mL [40-319] versus 55 pg/mL [31-99]; P=0.027). NT-proBNP, adjusted for age and CARPREG II risk score, was significantly associated with combined heart failure and preeclampsia (adjusted odds ratio, 2.14 [95% CI, 1.48-3.10] per log NT-proBNP increase; P<0.001). NT-proBNP <200 pg/mL had a specificity of 91% and negative predictive value of 95% in predicting combined heart failure and preeclampsia. NT-proBNP remains steady over the course of pregnancy with a transient increase during labor and delivery with higher levels in subgroups of stable cardiac patients. NT-proBNP level of 200 pg/mL can be used in the diagnosis of heart failure/preeclampsia in the pregnant cardiac population.

CARDIAC DISEASE IN PREGNANCY AND MATERNAL OUTCOME - A RETROSPECTIVE STUDY

Objectives : To evaluate the maternal outcomein patients with cardiac disease in pregnancy in terms of maternal complication and mode of delivery. Materials And Methods : Medical records of 50 women with heart disease who delivered at &gt;/= 28 weeks of gestation from March 2018 to February 2022 at Department of Obstetrics and Gynecology ,Basaweshwara Hospital ,attached to MahadevappaRampure Medical college ,Kalaburgi , were studied . Results : The prevalence of heart disease in pregnancy was 1%.There were 6(12%) with congenital heart disease(CHD) and 36(72%) with rheumatic heart disease(RHD), other lesions were 8(16%).76% of the women from rural background , 24% of the women from urban background .Isolated Mitral Regurgitation(MR) was the most common defect in rheumatic heart disease , atrial septal defect is the most common congenital lesion seen.64% of women remained NYHA class I throughout pregnancy. Heart failure developed in 2 patients whose NYHA changed from I/II to III /IV .18 women underwent corrective procedures prior or during pregnancy had good outcome. The maternal mortality was 2%.The incidence of preterm labor was 8%. Majority of the women delivered by spontaneous vaginal delivery 18(36%) while 16(32%) had caesarean section ,14(28%) had instrumental vaginal delivery , 2(4%) had vaginal delivery after induction . Conclusion: Cardiac disease is an important cause of maternal morbidity and mortality. Patients with NYHA class I/II had a better maternal outcome than those with NYHA class III/IV. Surgical correction of the cardiac lesion prior to pregnancy was associated with better pregnancy outcome.

CARPEG score as predictor of maternal and fetal outcomes in pregnancies complicated by cardiac disease

Background: Co-existing cardiac diseases in pregnancy poses unique challenges to anaesthesiologists and obstetricians. Heart diseases are estimated to complicate 1-3% of all pregnancies. It is a major contributing cause of maternal mortality and fetal complications.This study was designed to predict maternal and fetal outcomes in pregnancies complicated by cardiac diseases using Cardiac disease in Pregnancy (CARPREG) score. Aims and Objectives: 1.Predicting maternal mortality and adverse cardiac events during peripartum period using CARPREG score. 2.Evaluating neonatal outcomes in the pregnancies complicated by cardiac diseases. 3.To assess various cardiac conditions complicating pregnancies. Materials and Methods: A prospective observational study was designed to assess maternal and fetal outcomes using CARPREG score in 60 pregnancies complicated by cardiac diseases in the obstetric department of a tertiary care centre in South India between 2019-2021. CARPREG score includes New York Heart Association (NYHA) class, systolic ejection fraction, left ventricular obstruction and history of cardiac events assigning one point for each parameter; maximum being four. CARPREG score is validated for scores 0, 1 and 2 or more than 2 to be associated with cardiac event rates of 5%, 27% and 75% respectively.Results: Rheumatic heart disease (46.66%) followed by congenital heart diseases (31.66%) were the predominant cardiac diseases.

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

The healthcare experiences of women with cardiac disease in pregnancy and postpartum: A qualitative study.

IntroductionCardiac disease affects an estimated 1%–4% of all pregnancies and is a leading cause of maternal morbidity and mortality. There is a lack of data on the healthcare experiences of affected women to inform health service delivery and person‐centred care. This study sought to explore and understand the healthcare experiences of women with cardiac disease in pregnancy and postpartum.MethodsThis qualitative study used semi‐structured interviews with women who had cardiac disease in pregnancy or the first 12 months postpartum. Data were analysed using thematic analysis.ResultsParticipants were 25 women with pre‐existing or newly diagnosed acquired, genetic and congenital cardiac disease. Analysis of the interviews highlighted the discrepancy between care aspirations and experiences. The participants had a wide range of cardiac diseases and timing of diagnoses, but had similar healthcare experiences of being dismissed, not receiving the information they required, lack of continuity of care and clinical guidelines and of feeling out of place within a healthcare system that did not accommodate their combined needs as a mother and a cardiac patient.ConclusionThis study identified a lack of person‐centred care and responsiveness of the healthcare system in providing fit‐for‐purpose healthcare for women with complex disease who are pregnant or new mothers. In particular, cardiac and maternity care providers have an opportunity to listen to women who are the experts on their emergent healthcare needs, contributing to development of the knowledge base on the healthcare experiences of having cardiac disease in pregnancy and postpartum.Patient or Public ContributionPublic and patient input into the value and design of the study was gained through NSW Heart Foundation forums, including the Heart Foundation's women's patient group.

Cardiac disease in pregnancy and the first year postpartum: a story of mental health, identity and connection

BackgroundWomen with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum.MethodsA qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework.ResultsAnalysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing.ConclusionAcknowledging and understanding the breadth, complexity and depth of women’s experiences is fundamental to improving outcomes. Our findings provide unique insights into women’s experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.