Matthew Cauldwell1, Sarah Ghonim2, Anselm Uebing2, Lorna Swan2, Philip J Steer3, Michael Gatzoulis2, Mark R Johnson4. 1. Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Electronic address: mrc100@ic.ac.uk. 2. Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. 3. Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. 4. Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Electronic address: mark.johnson@imperial.ac.uk.
Abstract
OBJECTIVE: All women with CHD, especially those with more severe disease, should be offered preconception counseling (PCC), to discuss the risk of complications and to plan a future pregnancy. Several scoring system have been devised to estimate the risk of adverse events in pregnancies complicated by maternal heart disease (HD) and while comparisons have been made across the whole population, none have focused on the high-risk population. METHODS: Retrospective cohort study that included women classed as modified WHO (mWHO) 3 and 4 who had a pregnancy from at least 20weeks gestation between 1994 and 2015 managed within our institution. We assessed how well the quoted risk (at PCC) of an adverse event (maternal or fetal) related to the actual rate of occurrence. We calculated NYHA and CARPREG scores for all patients, and the clinician assessment of percentage risk, to predict the occurrence of an adverse outcome. RESULTS: We identified 76 mWHO 3 and 4 women who had a total of 102 pregnancies. However, only in 63 pregnancies had the woman attended PCC. Both maternal and fetal adverse events were common. NYHA did not significantly predict any adverse events, whilst a CARPREG score of >3 score predicted heart failure and mWHO4 score predicted maternal death. However, the best prediction of adverse outcomes was a composite quoted risk (percent) given at PCC. CONCLUSIONS: Women must have access to PCC as those with worse CARPREG and mWHO scores encounter greater adverse events.
OBJECTIVE: All women with CHD, especially those with more severe disease, should be offered preconception counseling (PCC), to discuss the risk of complications and to plan a future pregnancy. Several scoring system have been devised to estimate the risk of adverse events in pregnancies complicated by maternal heart disease (HD) and while comparisons have been made across the whole population, none have focused on the high-risk population. METHODS: Retrospective cohort study that included women classed as modified WHO (mWHO) 3 and 4 who had a pregnancy from at least 20weeks gestation between 1994 and 2015 managed within our institution. We assessed how well the quoted risk (at PCC) of an adverse event (maternal or fetal) related to the actual rate of occurrence. We calculated NYHA and CARPREG scores for all patients, and the clinician assessment of percentage risk, to predict the occurrence of an adverse outcome. RESULTS: We identified 76 mWHO 3 and 4 women who had a total of 102 pregnancies. However, only in 63 pregnancies had the woman attended PCC. Both maternal and fetal adverse events were common. NYHA did not significantly predict any adverse events, whilst a CARPREG score of >3 score predicted heart failure and mWHO4 score predicted maternal death. However, the best prediction of adverse outcomes was a composite quoted risk (percent) given at PCC. CONCLUSIONS:Women must have access to PCC as those with worse CARPREG and mWHO scores encounter greater adverse events.
Authors: Betül Toprak; Katharina Govorov; Katinka Kurz; Dora Csengeri; Jessica Weimann; Dennis Witte; Kurt Hecher; Bettina Hollwitz; Anne Hansen; Carsten Rickers; Christina Magnussen; Yskert von Kodolitsch; Tanja Zeller; Stefan Blankenberg; Christoph Sinning; Paulus Kirchhof; Elvin Zengin-Sahm Journal: Cardiovasc Diagn Ther Date: 2021-12
Authors: Lisa M Korst; Kimberly D Gregory; Lisa A Nicholas; Samia Saeb; David J Reynen; Jennifer L Troyan; Naomi Greene; Moshe Fridman Journal: Matern Health Neonatol Perinatol Date: 2021-01-06