Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 165–170
Contents lists available at ScienceDirect
Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health journal homepage: www.elsevier.com/locate/preghy
Original Article
Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands E. Hink 1,⇑, A.C. Bolte 1 VU University Medical Centre, Boelelaan 1117, Department of Gynecology and Obstetrics, 1081 HZ Amsterdam, The Netherlands
a r t i c l e
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Article history: Received 1 September 2014 Received in revised form 19 October 2014 Accepted 21 December 2014 Available online 5 January 2015 Keywords: Heart disease Pregnancy Maternal outcomes Neonatal outcome
a b s t r a c t Objectives: Clinical data of pregnant women with heart disease were obtained with the intention to provide input for local counseling and management guidelines. Study design: Retrospective data from all pregnant women with congenital or acquired heart disease between 2000 and 2011 in the VU University Medical Centre Amsterdam. Main outcome measures: Maternal and neonatal outcomes were evaluated. Results: Data of 122 women with 160 pregnancies were obtained. The most common heart diseases were congenital heart disease (n = 65, 53.3%) and arrhythmia (n = 20, 16.4%). Based on the functional criteria of the New York Heart Association (NYHA), 114/122 patients (93.4%) were classified NYHA class I–II. Patients in NYHA class III–IV (n = 8/122, 6.6%), mainly had a history of myocardial infarction or pulmonary hypertension. There were 156 singleton and 4 twin pregnancies. 22 (13.5%) pregnancies were complicated by hypertensive disorders. Heart failure developed in 11 women (9.0%), 37.5% in NYHA class III–IV and 6.5% in NYHA class I–II. Mean gestational age and birth weight were 270 days and 3196 g in NYHA class I–II compared to 237 days and 1972 g for NHYA class III–IV. There were two maternal deaths (1.6%) and 5 fetal deaths (3.1%). There were 29 (12.8%) preterm births, 20 (12.8%) neonates small for gestational age and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU). Conclusions: Pregnancy in women with pre-existing heart disease in all NYHA classes is associated with increased maternal morbidity and perinatal morbidity. Risk of structural fetal anomalies is especially high in women with congenital heart disease. Ó 2015 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
Introduction Heart disease is the leading cause of indirect maternal deaths [1]. The number of women presenting with cardiac disease during pregnancy is increasing because more
⇑ Corresponding author at: Bachstraat 25, 6521 EH Nijmegen, The Netherlands. Tel.: +31 243092521, mobile: +31 (0)650426737. E-mail addresses: [email protected], [email protected] (E. Hink), [email protected] (A.C. Bolte). 1 Radboud University Medical Centre, Department of Gynecology and Obstetrics, Route 791, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
women with repaired congenital heart disease are reaching childbearing age and because of more pregnancies occurring in women with ischemic heart disease. Pregnancy for women with heart disease is of moderate to high risk. A normal heart is able to tolerate the physiological hemodynamic changes during pregnancy (decrease of systemic vessel resistance, increase of blood volume, increase of heart rate and cardiac output). For a pregnant woman with an impaired cardiac function these changes increase the cardiac burden and may lead to maternal and perinatal complications during pregnancy and delivery [2–4]. Evaluation of perinatal and maternal outcomes in women with heart disease can be helpful in preconceptional counseling
http://dx.doi.org/10.1016/j.preghy.2014.12.001 2210-7789/Ó 2015 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
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E. Hink, A.C. Bolte / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 165–170
about maternal and perinatal risks for women with heart disease. The VU University Medical Centre is a tertiary care center with a large catchment area. Clinical data of pregnant women with heart disease that received obstetric care and delivered in our center have been obtained with the intention to evaluate the cardiac and obstetric pregnancy outcomes and to provide data for local counseling and management guidelines. Methods Data on maternal outcome and neonatal outcome were collected in women with heart disease who delivered in the VU University Medical Centre in Amsterdam, The Netherlands between 2000 and 2011. Baseline data were obtained before pregnancy or at the first antenatal visit including age, gravidity, parity, congenital or acquired heart disease, nature of underlying heart disease, functional class using the criteria of the New York Heart Association (NYHA) and prior cardiac intervention. During pregnancy at least one consultation with a specialized cardiologist and anesthetist took place. In the high-risk group (NYHA III–IV) multidisciplinary consultation with a team consisting of a cardiologist, intensive care specialist, in obstetrics and cardiology specialized anesthetists and a neonatologist was performed at least once. In women with congenital heart disease fetal echocardiography is performed routinely at least once because of increased risk of cardiac disease in the offspring. Data were retrospectively collected from patients’ charts. The study design was reviewed by the medical ethics committee of the VU University Medical Centre in Amsterdam. Pregnancy outcome, perinatal outcome and maternal complications Pregnancy outcomes included: single or multiple pregnancy, induction of labor, termination of pregnancy, maternal complications, mode of delivery, use and type of analgesia during delivery. Fetal and neonatal complications included: fetal structural (heart) defects, preterm delivery (
Contents lists available at ScienceDirect
Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health journal homepage: www.elsevier.com/locate/preghy
Original Article
Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands E. Hink 1,⇑, A.C. Bolte 1 VU University Medical Centre, Boelelaan 1117, Department of Gynecology and Obstetrics, 1081 HZ Amsterdam, The Netherlands
a r t i c l e
i n f o
Article history: Received 1 September 2014 Received in revised form 19 October 2014 Accepted 21 December 2014 Available online 5 January 2015 Keywords: Heart disease Pregnancy Maternal outcomes Neonatal outcome
a b s t r a c t Objectives: Clinical data of pregnant women with heart disease were obtained with the intention to provide input for local counseling and management guidelines. Study design: Retrospective data from all pregnant women with congenital or acquired heart disease between 2000 and 2011 in the VU University Medical Centre Amsterdam. Main outcome measures: Maternal and neonatal outcomes were evaluated. Results: Data of 122 women with 160 pregnancies were obtained. The most common heart diseases were congenital heart disease (n = 65, 53.3%) and arrhythmia (n = 20, 16.4%). Based on the functional criteria of the New York Heart Association (NYHA), 114/122 patients (93.4%) were classified NYHA class I–II. Patients in NYHA class III–IV (n = 8/122, 6.6%), mainly had a history of myocardial infarction or pulmonary hypertension. There were 156 singleton and 4 twin pregnancies. 22 (13.5%) pregnancies were complicated by hypertensive disorders. Heart failure developed in 11 women (9.0%), 37.5% in NYHA class III–IV and 6.5% in NYHA class I–II. Mean gestational age and birth weight were 270 days and 3196 g in NYHA class I–II compared to 237 days and 1972 g for NHYA class III–IV. There were two maternal deaths (1.6%) and 5 fetal deaths (3.1%). There were 29 (12.8%) preterm births, 20 (12.8%) neonates small for gestational age and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU). Conclusions: Pregnancy in women with pre-existing heart disease in all NYHA classes is associated with increased maternal morbidity and perinatal morbidity. Risk of structural fetal anomalies is especially high in women with congenital heart disease. Ó 2015 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
Introduction Heart disease is the leading cause of indirect maternal deaths [1]. The number of women presenting with cardiac disease during pregnancy is increasing because more
⇑ Corresponding author at: Bachstraat 25, 6521 EH Nijmegen, The Netherlands. Tel.: +31 243092521, mobile: +31 (0)650426737. E-mail addresses: [email protected], [email protected] (E. Hink), [email protected] (A.C. Bolte). 1 Radboud University Medical Centre, Department of Gynecology and Obstetrics, Route 791, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
women with repaired congenital heart disease are reaching childbearing age and because of more pregnancies occurring in women with ischemic heart disease. Pregnancy for women with heart disease is of moderate to high risk. A normal heart is able to tolerate the physiological hemodynamic changes during pregnancy (decrease of systemic vessel resistance, increase of blood volume, increase of heart rate and cardiac output). For a pregnant woman with an impaired cardiac function these changes increase the cardiac burden and may lead to maternal and perinatal complications during pregnancy and delivery [2–4]. Evaluation of perinatal and maternal outcomes in women with heart disease can be helpful in preconceptional counseling
http://dx.doi.org/10.1016/j.preghy.2014.12.001 2210-7789/Ó 2015 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
166
E. Hink, A.C. Bolte / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 165–170
about maternal and perinatal risks for women with heart disease. The VU University Medical Centre is a tertiary care center with a large catchment area. Clinical data of pregnant women with heart disease that received obstetric care and delivered in our center have been obtained with the intention to evaluate the cardiac and obstetric pregnancy outcomes and to provide data for local counseling and management guidelines. Methods Data on maternal outcome and neonatal outcome were collected in women with heart disease who delivered in the VU University Medical Centre in Amsterdam, The Netherlands between 2000 and 2011. Baseline data were obtained before pregnancy or at the first antenatal visit including age, gravidity, parity, congenital or acquired heart disease, nature of underlying heart disease, functional class using the criteria of the New York Heart Association (NYHA) and prior cardiac intervention. During pregnancy at least one consultation with a specialized cardiologist and anesthetist took place. In the high-risk group (NYHA III–IV) multidisciplinary consultation with a team consisting of a cardiologist, intensive care specialist, in obstetrics and cardiology specialized anesthetists and a neonatologist was performed at least once. In women with congenital heart disease fetal echocardiography is performed routinely at least once because of increased risk of cardiac disease in the offspring. Data were retrospectively collected from patients’ charts. The study design was reviewed by the medical ethics committee of the VU University Medical Centre in Amsterdam. Pregnancy outcome, perinatal outcome and maternal complications Pregnancy outcomes included: single or multiple pregnancy, induction of labor, termination of pregnancy, maternal complications, mode of delivery, use and type of analgesia during delivery. Fetal and neonatal complications included: fetal structural (heart) defects, preterm delivery (
