Author + information
- Aarthi Sabanayagam,
- Anushree Agarwal,
- Christy MacCain,
- Elizabeth Lawton,
- Elliot Main,
- Afshan Hameed,
- Ian Harris and
- Elyse Foster
Background: Heart disease accounts for ∼10% of mortality and morbidity during pregnancy. Congenital heart disease (CHD) is the most common cardiac condition affecting women during pregnancy. Despite improvements in survival and quality of life for patients with CHD, pregnancy remains high risk or even contraindicated in some of these women.
Methods: Maternal mortality rates increased from 2002-2006 in California. The California Pregnancy-Associated Mortality Review identified 917 women who died while pregnant or within the first year of delivery. All available inpatient and outpatient records for women with CHD were reviewed. Deaths were deemed pregnancy related if death was directly related or aggravated due to the physiological changes of pregnancy and/or its management (n=286).
Results: Eight women (mean age was 26.6 +/- 7.4 years, 6 Hispanic and 2 African American) were identified with CHD (Eisenmenger's=2, Congenital Corrected Transposition of the Great Vessels=1, Tetralogy of Fallot = 1, Ventricular septal defect = 1, Atrial septal defect = 2, Bicuspid Valve/Severe aortic stenosis = 1). The first prenatal visit occurred at a mean of 12.7 +/-6.2 weeks. Average gestational age at the time of delivery was 33.8 +/- 5.5 weeks. Six of these women were aware of their cardiac diagnosis prior or during their pregnancy and 6 underwent emergent C-section. Three women died of sudden cardiac death and 1 within the first 24 hours of delivery. Six deaths were thought to be pregnancy related and 5 were within 6 weeks of delivery. Retrospective use of the ZAHARA risk model predicted an increased risk (>=7.5%) of cardiovascular events in 5 women.
Conclusions: This descriptive series gives a rare insight into the events surrounding death in this unique population. Despite seeking early prenatal care, these women had less than ideal follow-up for their CHD during pregnancy. The progression of the underlying disease process once these women presented was rapid if not instantaneous. This underscores the importance of a multidisciplinary team of specialized cardiologists, high-risk obstetricians in following these patients throughout pregnancy as well as in the early post-partum period.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Adult Patients With Congenital Heart Disease: How Do They Compare?
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1142-012
- 2017 American College of Cardiology Foundation