Titia P E Ruys1, Jolien W Roos-Hesselink1, Antonia Pijuan-Domènech2, Elena Vasario3, Ilshat R Gaisin4, Bernard Iung5, Leisa J Freeman6, Elaine P Gordon7, Petronella G Pieper8, Roger Hall6, Eric Boersma1, Mark R Johnson9. 1. Cardiology Department, Erasmus Medical Centre, Rotterdam, The Netherlands. 2. Integrated Adult Congenital Heart Disease Unit of Vall d' Hebron-Sant Pau University Hospitals. Division of Cardiology. Vall d' Hebron University Hospital. Barcelona, Spain. 3. Department of Obstetrics and Neonatology, Sant'Anna Hospital, Torino, Italy. 4. Hospital Therapy Department, Izhevsk State Medical Academy, Izhevsk, Russian Federation. 5. Cardiology Department, Bichat Hospital, Paris, France. 6. Cardiology Department, Norfolk & Norwich University NHS Hospital, Norwich, UK. 7. Cardiology Department, McMaster University, Hamilton, Ontario, Canada. 8. Cardiology Department, University Medical Centre Groningen, Groningen, The Netherlands. 9. Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK.
Abstract
OBJECTIVES: In the general population, planned caesarean section is thought to be safer in high-risk situations as it avoids the greater risk of an emergency caesarean section. Only limited data exist on the optimal mode of delivery in women with structural heart disease. We investigated the relationship between mode of delivery and pregnancy outcome in women with pre-existing heart disease. METHODS: The Registry on Pregnancy and Cardiac Disease is an on-going, global, prospective observational registry of women with structural heart disease. We report on 1262 deliveries, between January 2007 and June 2011. RESULTS: The caesarean section was planned in 393 women (31%): 172 (44%) for cardiac and 221 (56%) for obstetric reasons of whom 53 delivered by emergency caesarean section. Vaginal delivery was planned in 869 (69%) women, of whom 726 (84%) actually delivered vaginally and 143 (16%) had an emergency caesarean section. Perinatal mortality(1.1 vs 2.7, p=0.14) and low apgar score (11.9 vs 10.1, p=0.45) were not significantly different in women who had a caesarean section or vaginal delivery; gestational age(37 vs 38 weeks p=0.003) and birth weight (3073 vs 2870 g p<0.001) were lower in women delivered by caesarean section compared with women delivered by vaginal delivery. In those delivered by elective or emergency caesarean section, there was no difference in maternal mortality (1.8% vs 1.5%, p=1.0), postpartum heart failure (8.8% vs 8.2% p=0.79) or haemorrhage (6.2% vs 5.1% p=0.61). CONCLUSIONS: These data suggest that planned caesarean section does not confer any advantage over planned vaginal delivery, in terms of maternal outcome, but is associated with an adverse fetal outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: In the general population, planned caesarean section is thought to be safer in high-risk situations as it avoids the greater risk of an emergency caesarean section. Only limited data exist on the optimal mode of delivery in women with structural heart disease. We investigated the relationship between mode of delivery and pregnancy outcome in women with pre-existing heart disease. METHODS: The Registry on Pregnancy and Cardiac Disease is an on-going, global, prospective observational registry of women with structural heart disease. We report on 1262 deliveries, between January 2007 and June 2011. RESULTS: The caesarean section was planned in 393 women (31%): 172 (44%) for cardiac and 221 (56%) for obstetric reasons of whom 53 delivered by emergency caesarean section. Vaginal delivery was planned in 869 (69%) women, of whom 726 (84%) actually delivered vaginally and 143 (16%) had an emergency caesarean section. Perinatal mortality(1.1 vs 2.7, p=0.14) and low apgar score (11.9 vs 10.1, p=0.45) were not significantly different in women who had a caesarean section or vaginal delivery; gestational age(37 vs 38 weeks p=0.003) and birth weight (3073 vs 2870 g p<0.001) were lower in women delivered by caesarean section compared with women delivered by vaginal delivery. In those delivered by elective or emergency caesarean section, there was no difference in maternal mortality (1.8% vs 1.5%, p=1.0), postpartum heart failure (8.8% vs 8.2% p=0.79) or haemorrhage (6.2% vs 5.1% p=0.61). CONCLUSIONS: These data suggest that planned caesarean section does not confer any advantage over planned vaginal delivery, in terms of maternal outcome, but is associated with an adverse fetal outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Sarah Rae Easter; Caroline E Rouse; Valeria Duarte; Jenna S Hynes; Michael N Singh; Michael J Landzberg; Anne Marie Valente; Katherine E Economy Journal: Am J Obstet Gynecol Date: 2019-07-13 Impact factor: 8.661
Authors: Melinda B Davis; Katherine Arendt; Natalie A Bello; Haywood Brown; Joan Briller; Kelly Epps; Lisa Hollier; Elizabeth Langen; Ki Park; Mary Norine Walsh; Dominique Williams; Malissa Wood; Candice K Silversides; Kathryn J Lindley Journal: J Am Coll Cardiol Date: 2021-04-13 Impact factor: 24.094