Key result
Intended vaginal delivery carries no increased risk of severe maternal morbidity vs cesarean in cardiomyopathy.
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Why the study?
Women with cardiomyopathies risk pregnancy complications, but the optimal mode of delivery has been guided only by expert opinion and limited small studies.
Does intended vaginal delivery reduce non-transfusion severe maternal morbidity in pregnant patients with cardiomyopathies?
Cohort (n=2,921)
Yes
Does intended vaginal delivery reduce non-transfusion severe maternal morbidity in pregnant patients with cardiomyopathies?
A trial of labor is a safe option for most pregnant patients with cardiomyopathies, as it does not increase the risk of severe maternal morbidity compared to planned cesarean delivery.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These findings support the current guideline recommendations to avoid cesarean delivery in the absence of an obstetric or fetal indication”
Intended vaginal delivery was not linked to higher severe maternal morbidity in cardiomyopathies; observational data leaves open whether guidelines should shift.
Background: Women with cardiomyopathies are at risk for pregnancy complications. Optimal mode of delivery in these patients is guided by expert opinion and limited small studies. Objectives: The objective of this study is to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization and readmissions among patients with cardiomyopathies. Methods: The Premier inpatient administrative database was used to conduct a retrospective cohort study of pregnant patients with a diagnosis of a cardiomyopathy. Utilizing a target trial emulation strategy, the primary analysis compared outcomes among patients exposed to intended vaginal delivery versus intended cesarean delivery (intention to treat). A secondary analysis compared outcomes among patients who delivered vaginally versus by cesarean (as-treated). Outcomes examined were non-transfusion severe maternal morbidity during the delivery hospitalization, blood transfusion and readmission. Results: The cohort consisted of 2,921 deliveries. In the primary analysis (intention to treat), there was no difference in non-transfusion morbidity (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 0.91–1.51), blood transfusion (aOR, 1.27; 95% CI, 0.81–1.98) or readmission (aOR, 1.03; 95% CI, .73–1.44) between intended vaginal delivery and intended cesarean delivery. In the as-treated analysis, cesarean delivery was associated with a 2-fold higher risk of non-transfusion morbidity (aOR, 2.44; 95% CI, 1.85–3.22) and blood transfusion (aOR, 2.26; 95% CI, 1.34–3.81) when compared to vaginal delivery. Conclusions: In patients with cardiomyopathies, a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion or readmission compared with planned cesarean delivery.
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Meng et al. (2023) conducted a cohort in Cardiomyopathy in pregnancy (n=2,921). Intended vaginal delivery vs. Intended cesarean delivery was evaluated on Any non-transfusion severe maternal morbidity during the delivery hospitalization (aOR 1.17, 95% CI 0.91-1.51). In pregnant patients with cardiomyopathies, intended vaginal delivery did not confer a higher risk of non-transfusion severe maternal morbidity compared to intended cesarean delivery (aOR 1.17, 95% CI 0.91-1.51).
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