Why the study?
Pregnant women with cardiac disease pose clinical challenges, particularly in developing countries with limited resources, prompting this evaluation of clinical features and pregnancy outcomes in Vietnam.
Does high-risk clinical stratification predict adverse pregnancy outcomes in pregnant women with cardiac diseases?
Cohort (n=134)
No
Does high-risk clinical stratification predict adverse pregnancy outcomes in pregnant women with cardiac diseases?
Odds Ratio: 0.097 (95% CI 0.02–0.43)
Absolute Event Rate: 55.6% vs 92.8%
p-value: p=<0.05
In pregnant women with cardiac diseases in a resource-limited setting, high-risk clinical features (LVEF <50%, NYHA >II, cyanosis, or left heart obstruction) are associated with significantly higher rates of premature delivery and maternal complications.
Background: Pregnant women with cardiac diseases present a challenge for both obstetricians and cardiologists, especially in developing countries with limited medical resources. This study aimed to determine the clinical features and pregnancy outcomes of pregnant women with cardiac diseases in Vietnam. Methods: In this patient registry descriptive study, pregnant women with heart disease, admitted to the Department of Obstetrics and Gynecology, Hue Central Hospital, Vietnam, between January 2017 and December 2020, were recruited. Pregnant women were classified into the high-risk group if at least one of the following risk clinical features was present: (1) left ventricular ejection fraction (EF) <50%, and (2) New York Heart Association—NYHA classification—NYHA class >II or cyanosis, or (3) left heart obstruction; patients without these risk conditions were categorized into the low-risk group. Results: A total of 134 pregnant women were included, with a mean age of 27.8 ± 4.8 years old; 32.1% had mitral valve disease, 23.9% had rhythm disorders, 15.7% had congenital heart disease, 9.0% had aortic valve disease, and 3.0% had both mitral and aortic valve disease. Maternal complications during pregnancy included heart failure (37.3%), irregular heart rhythm (35.8%), thrombosis (0.7%), and valve blockage (0.7%). A total of 66.7% of the high-risk patients underwent cesarean section, 22.2% with therapeutic abortion, and 11.1% with miscarriage. The frequency of gestational age over 35 weeks in the high-risk and low-risk groups were 55.6% and 92.8%, respectively (Odds ratios = 0.097, 95% Confidence Interval: 0.02–0.43, p < 0.05). The mean birth weight in the high-risk and low-risk groups was 2800.0 ± 438.2 and 2988.4 ± 390.6 g, p > 0.05, respectively. Conclusions: Cardiovascular disorders in pregnant women have a higher rate of complications that affect mother and fetus. Risk stratification plays an important role in management during pregnancy and is essential to improve the outcomes in developing countries with limited medical resources.
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Lê et al. (2022) conducted a cohort in Cardiac disease in pregnancy (n=134). High-risk cardiac features vs. Low-risk cardiac features was evaluated on Gestational age over 35 weeks (OR 0.097, 95% CI 0.02-0.43, p=<0.05).
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