Research Article
Maternal Kalp Hastalığının Doğum Şekli ve Olumsuz Perinatal Sonuçlar Üzerindeki Etkilerinin Değerlendirilmesi: 10 Yıllık Tersiyer Merkez Deneyimi
Abstract
Amaç: Bu çalışmanın amacı, gebelik sırasındaki ciddi maternal kalp hastalığının doğum şekli ve olumsuz perinatal sonuçlar üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: 2010-2020 yılları arasında kalp hastalığı olup tersiyer bir merkezde doğum yapan 108 gebeyi içermektedir. Gebelerin kalp hastalığı tipine ve modifiye edilmiş Dünya Sağlık Örgütü sınıflandırmasına göre doğum şekli, olumsuz maternal ve perinatal sonuçlar yorumlandı.
Bulgular: Gebelerin modifiye edilmiş Dünya Sağlık Örgütü sınıflamalarına göre dağılımları sınıf I, II, III ve IV'e sırasıyla %56.4, %26.8, %11.2 ve %5.6 olarak saptandı. Kardiak patoloji dağılımında romatizmal kalp kapak hastalığı %65.7, konjenital kalp anomalisi %21.2 ve diğer kalp hastalıkları %13.1 oranında izlendi. Nulliparite, etnik köken ve sezaryen öyküsü oranları sınıflar arasında benzerdi. Doğumdaki gebelik yaşı ve doğum ağırlığı, sınıf III-IV'te sınıf I-II'ye göre önemli ölçüde daha düşüktü. Sınıf III-IV'te prematürite, gestasyonel yaşa göre küçük olanlar ve yenidoğan yoğun bakım ünitesine yatışın diğer sınıflara göre artmış olduğu görüldü. Sınıf III-IV ve sınıf I-II karşılaştırıldığında vajinal doğum oranları Sınıf I-II de 54 (%60) iken Sınıf III-IV de 10 (%55.5) olarak izlendi. Sezaryen sayıları Sınıf I-II de 36 (%40), Sınıf III-IV de 8 (%44.5) olarak saptandı. Sezaryen sayıları arasında anlamlı bir farklılık mevcuttu. Olumsuz obstetrik sonuçların varlığı benzerdi. Bu periyot diliminde 3 anne ölümü meydana geldi. Anne morbiditesi ve anne ölümü, sınıf I-II'ye kıyasla sınıf III-IV'te daha yüksek olarak gözlendi.
Sonuç: Kardiyak hastalıkları olan gebelere, maternal mortalite ve morbidite yanında olumsuz fetal sonuçları azaltmak için de hem obstetrisyen hem de kardiyolog olacak şekilde multidisipliner bir yaklaşım uygulanmalıdır.
References
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- 6. Kuklina EV, Callaghan WM. Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA: 1995-2006. BJOG. 2011;118(3):345-52.
- 7. Briller J, Koch AR, Geller SE. Maternal cardiovascular mortality in Illinois, 2002–2011. Obstet Gynecol. 2017;129(5):819-26.
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- 13. Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician. 2009;55(2):155.
- 14. Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol. 2015;126(2):346.
- 15. Erolu E, Sarısoy Ö. Fetal echocardiography characteristics in a tertiary center. Erciyes Med J. 2020;42(2):143-6.
- 16. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49(24):2303-11.
- 17. Madazli R, Şal V, Çift T, Guralp O, Goymen A. Pregnancy outcomes in women with heart disease. Arch Gynecol Obstet. 2010;281(1):29.
- 18. Ruys TP, Roos-Hesselink JW, Pijuan-Domènech A, Vasario E, Gaisin IR, Iung B et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101(7):530-6.
- 19. Endorsed by the European Society of Gynecology tAfEPC, Medicine tGSfG, Members ATF, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-97.
- 20. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cifkova R, De Bonis M et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(34):3165-241.
- 21. Elkayam U, Goland S, Pieper PG, Silversides CK. High-risk cardiac disease in pregnancy: part I. J Am Coll Cardiol. 2016;68(4):396-410.
EVALUATION OF MATERNAL HEART DISEASE EFFECTS ON MODE OF DELIVERY AND ADVERSE PERINATAL OUTCOMES: A 10 YEARS’ EXPERIENCE OF A REFERENCE CENTER
Abstract
Objective: The aim of the present study was to evaluate the effect of severe maternal cardiac disease during pregnancy on mode of delivery and adverse perinatal outcomes.
Material and Methods: The study comprised 108 pregnant women with cardiac disorder who delivered at a tertiary care center hospital between 2010 and 2020. Mode of delivery, adverse maternal and perinatal outcomes was interpreted according to the woman’s status based on her type of heart disease and a modified World Health Organization classification.
Results: The distributions of the women according to the modified World Health Organization classifications were 56.4%, 26.8%, 11.2%, and 5.6% for WHO classes I, II, III, and IV, respectively. The ratios of cardiac diseases were 65.7%, 21.2%, and 13.1%, respectively, for rheumatic, and congenital heart disorder, and others. Nulliparity, ethnicity, and history of caesarean section rates were similar among the classes. Gestational age at delivery and birth weight were significantly lower in classes III–IV than in classes I–II. Prematurity, small for gestational age rates, and admission to neonatal intensive care unit were increased in classes III–IV compared to those in classes I–II. While vaginal delivery rates were 54 (60%) in Class I-II and 10 (55.5%) in Class III-IV, the cesarean section rates were 36 (40%) in Class I-II and 8 (44.5%) in Class III-IV. There was a significant difference between the cesarean section rates. The presence of adverse obstetrical outcomes was similar among the classes. During this period, a total of 3 maternal mortalities occurred. Maternal morbidity and maternal mortality were increased in classes III–IV compared those in classes I–II.
Conclusion: Pregnant women with cardiac diseases should be administered using a multidisciplinary approach that combines consultants from both obstetrics and cardiology to reduce maternal mortality and morbidity and adverse fetal outcomes.
References
- 1. Hollier LM, Martin Jr JN, Connolly H, Turrentine M, Hameed A, Arendt KW et al. Pregnancy and heart disease. Obstet Gynecol. 2019;133(5):E320-E56.
- 2. Curry R, Swan L, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol. 2009;21(6):508-13.
- 3. Fett JD. Peripartum cardiomyopathy: challenges in diagnosis and management. Expert Rev Cardiovasc Ther. 2016;14(9):1035-41.
- 4. Hameed AB, Lawton ES, McCain CL, Morton CH, Mitchell C, Main EK et al. Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. Am J Obstet Gynecol. 2015;213(3):379.e1-e10.
- 5. Gunderson EP, Croen LA, Chiang V, Yoshida CK, Walton D, Go AS. Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes. Obstet Gynecol. 2011;118(3):583-91.
- 6. Kuklina EV, Callaghan WM. Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA: 1995-2006. BJOG. 2011;118(3):345-52.
- 7. Briller J, Koch AR, Geller SE. Maternal cardiovascular mortality in Illinois, 2002–2011. Obstet Gynecol. 2017;129(5):819-26.
- 8. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D et al. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118:1-203.
- 9. Köşüş A, Köşüş N, Açıkgöz N, Çapar M. Kalp hastalığı olan ve olmayan gebelerde maternal ve fetal sonuçlar açisindan bir fark var mı? Genel Tıp Dergisi. 2008;18(2):55-60.
- 10. Ayşegül Ö, Hamzaoğlu K, Durmaz E, Madazlı R. Pregnancy outcomes of 115 cases with maternal heart disease. İstanbul Tıp Fakültesi Dergisi. 2020;83(1);17-22.
- 11. Roos-Hesselink JW, Ruys TP, Stein JI, Thilen U, Webb GD, Niwa K et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J. 2013;34(9):657-65.
- 12. Pavankumar P, Venugopal P, Kaul U, Iyer K, Das B, Sampathkumar A et al. Pregnancy in patients with prosthetic cardiac valve: a 10-year experience. Scand J Thorac Cardiovasc Surg. 1988;22(1):19-22.
- 13. Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician. 2009;55(2):155.
- 14. Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol. 2015;126(2):346.
- 15. Erolu E, Sarısoy Ö. Fetal echocardiography characteristics in a tertiary center. Erciyes Med J. 2020;42(2):143-6.
- 16. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49(24):2303-11.
- 17. Madazli R, Şal V, Çift T, Guralp O, Goymen A. Pregnancy outcomes in women with heart disease. Arch Gynecol Obstet. 2010;281(1):29.
- 18. Ruys TP, Roos-Hesselink JW, Pijuan-Domènech A, Vasario E, Gaisin IR, Iung B et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101(7):530-6.
- 19. Endorsed by the European Society of Gynecology tAfEPC, Medicine tGSfG, Members ATF, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-97.
- 20. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cifkova R, De Bonis M et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(34):3165-241.
- 21. Elkayam U, Goland S, Pieper PG, Silversides CK. High-risk cardiac disease in pregnancy: part I. J Am Coll Cardiol. 2016;68(4):396-410.
There are 21 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 31, 2021 |
| Submission Date | June 18, 2021 |
| Published in Issue | Year 2021 Volume: 23 Issue: 3 |
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Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.