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Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339

Introduction: Pre-eclampsia (PE) is a leading cause of maternal and foetal mortality and morbidity. Chronic Hypertension (CH) and a previous PE are well known risk factors for PE. If the prevalence of PE in nulliparous is about 2%, it raise up to 7–10% in women with CH or a previous PE. However, the role of these risk factors when PE occurs is still under discussion Objectives: To detect if maternal history of previous PE and/or Chronic Hypertension (CH) is associated with a worse clinical outcome in women affected by PE. Methods: Cohort study on 100 consecutive singleton pregnancies complicated by PE referred to our Department from January 2010 to December 2011. PE and CH were defined according to ISSHP criteria. Small for Gestational Age (SGA) was defined as Birth Weight under the 5th percentile per Gestational Age. Patients were divided into two groups depending on positive (Group A, n = 25) or negative (Group B, n = 75) history for PE and/or Chronic Hypertension (CH). Patients assessed to group A were under prophylactic therapy with ASA 100 mg oid. Clinical and perinatal outcomes were reviewed. Adverse Pregnancy Outcome (APO) was defined as Apgar score less than seven at five minutes, pH < 7.20; birth weight < 5th percentile (SGA), stillbirth or neonatal death. Results: Groups were comparable for Maternal Age (Group A: 34 years median, IQR 30–36yy; Group B: 34 years, IQD 28–36yy ) and BMI (Group A: 23.7 Kg/mq median, IQR 20.8–27.1 Kg/mq; Group B: 22.4 Kg/mq median IQR 20.3– 26.0 Kg/mq). One case of stillbirth (Group A) and four cases of neonatal death were observed, 1/25 in Group A (4%) and 3/75 (4%) in Group B. No differences were found in Gestational Age (GA) at diagnosis of PE (Group A: 32 + 2w median, IQR 28 + 0 35 + 4w; Group B: 33 + 2w median, IQR 30 + 0– 36 + 1w); GA at delivery (Group A: 34 + 1w median, IQR 31 + 5–36 + 5w; Group B: 34 + 2w median, IQR 32 + 0– 36 + 3w) Birth Weight percentile (Group A: 6th percentile median, IQR 2–21th percentile; Group B: 5th percentile median, IQR 1–15th percentile), prevalence of Small for Gestational Age (14/25 and 42/75, for Group A and B respectively), prevalence of APO (13/25 and 44/75, for Group A and B respectively). Conclusion: Our data suggest that a positive history for PE and/or CH does not influence clinical outcome in women affected by PE. This result could be explained by the administration of prophylactic ASA 100mg oid in this group of patients. Disclosure of interest: None declared.

doi:10.1016/j.preghy.2012.04.260

PP150. Pregnancy outcome in women with heart disease in a single tertiary care center E. Hink *, S.H. Luitjes, A.C. Bolte (Obstetrics & Gynaecology, VU University Medical Center, Amsterdam, The Netherlands) Introduction: The number of women presenting with cardiac disease during pregnancy is increasing because more women with repaired congenital heart disease are reaching

childbearing age and because of more pregnancies occurring in women with ischemic heart disease. Cardiac disease is the leading cause of indirect maternal mortality in the Netherlands. Objectives: 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 were collected from all pregnant women with congenital or acquired heart disease who delivered between 2000 and 2010 in the VU University Medical Center Amsterdam. At least one consultation of a cardiologist during pregnancy was advised. The maternal outcomes of these pregnancies were evaluated. Results: Data of 122 women with 160 pregnancies were obtained. In this study the main heart diseases in pregnancy were congenital heart disease (n = 75.61%) and arrhythmia (n = 22.18%). Rheumatic heart disease was accountable for 6% (n = 7) and ischemic heart disease for 4% (n = 5) of inclusions. 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. Of all the women, 35 had cardiac surgery before pregnancy, mainly repair of congenital heart disease. In women with acquired heart disease the interventions before pregnancy included permanent cardiac pace-maker implantation (n = 2), radiofrequency catheter ablation (RFCA) (n = 4) and percutaneous transluminal coronary angioplasty or coronary artery bypass graft (n = 4). There were 156 singleton and 4 twin pregnancies. Termination of pregnancy was performed in 3 cases; 1 for maternal cardiac and 2 for obstetric indications. There were 156 life-births of which 100 (64.1%) were spontaneous vaginal deliveries, 17 (10.9%) operative vaginal deliveries and 39 (25%) cesarean sections: 9 for maternal cardiac indication and 30 for obstetric reasons. 36 (36%) women received epidural analgesia during labor and delivery. Cesarean section under general anesthesia was performed in 14 cases (7 for maternal cardiac indication); 25 were performed under spinal/epidural anesthesia. Induction of labour occurred in 48 pregnancies: 10 for maternal cardiac indications and 38 for other maternal and fetal indications. 28 (17.5%) pregnancies were complicated by hypertensive disorders. Cardiac complications such as heart failure developed in 15 (9.4%) pregnancies. There were two maternal deaths (1.6%). Conclusion: Congenital heart disease is the type of heart disease that has the highest incidence in pregnancy, while main types of heart disease that lead to impaired cardiac function during pregnancy are ischemic disease and pulmonary hypertension. Incidence of pregnancy induced hypertensive disorders is increased in women with preexistent cardiac disorders. Maternal outcome is generally favourable for women with cardiac heart in NYHA class I/II. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.261

PP150. Pregnancy outcome in women with heart disease in a single tertiary care center.

The number of women presenting with cardiac disease during pregnancy is increasing because more women with repaired congenital heart disease are reach...
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