Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team - 01/06/24
, Jean Philippe Bonnet a, Capucine Coulon b, Olivia Domanski c, Benjamin Constans d, Max Gonzalez Estevez d, Sophie Gautier e, Luisa Marsili f, Yasmine Ould Hamoud b, Augustin Coisne a, g, h, i, j, Hélène Ridon a, Anne-Sophie Polge a, Stéphanie Mouton a, Yasmine Haddad a, Francis Juthier i, k, l, Mouhamed Moussa m, Claire Mounier Vehier n, Gilles Lemesle i, o, p, Guillaume Schurtz o, Charles Garabedian b, i, q, Mercedes Jourdain i, r, s, Sandro Ninni i, j, t, François Brigadeau t, David Montaigne a, h, i, j, Nicolas Lamblin i, o, u, Louise Ghesquiere b, i, qGraphical abstract |
Highlights |
• | Cardiovascular diseases are the main cause of maternal death. |
• | There is a call for improved care for pregnant patients with heart diseases. |
• | We describe the results of a French cardio-obstetric network. |
• | Management of these patients by a multidisciplinary Pregnancy Heart Team is promising. |
Abstract |
Background |
Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce.
Aims |
To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre.
Methods |
We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year.
Results |
We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5–12.2) during pregnancy and in three others (1.5%, 95% CI 0.3–4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy.
Conclusions |
The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.
Le texte complet de cet article est disponible en PDF.Keywords : Pregnant women, Heart valve diseases, Adult congenital heart diseases, Cardiomyopathy, Maternal mortality
Plan
Vol 117 - N° 5
P. 343-350 - mai 2024 Retour au numéro
Article précédent
- Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study
- Jean-Sébastien Hulot, Philip Janiak, Philippe Boutinaud, Pierre Boutouyrie, Frédérique Chézalviel-Guilbert, Jean-Joseph Christophe, Ariel Cohen, Thibaud Damy, Juliette Djadi-Prat, Hüseyin Firat, Pierre-Yves Hervé, Richard Isnard, Guillaume Jondeau, Elie Mousseaux, Mathieu Pernot, Pierre Prot, Benoit Tyl, Gilles Soulat, Damien Logeart, PACIFIC consortium
- Acute coronary syndrome in patients treated by vitamin K antagonists or non-vitamin K antagonist oral anticoagulants: Proposed management algorithm for the first 48 hours
- Alexandre Salaun, Emmanuel de Maistre, Marlène Daller, Chan Sombrun, Frédéric Chagué, Florence Bichat, Luc Rochette, Nicolas Danchin, Laurent Fauchier, Marianne Zeller, Yves Cottin
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?