Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart DiseaseReportar como inadecuado




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Background

Advances in cardiac surgery and congenital cardiology have led to an increasing number of women with congenital heart disease CHD reaching childbearing age. In general, cardiologists recommend vaginal delivery for women with CHD to avoid complications from Caesarean section as many women with CHD tolerate vaginal delivery well.

Methods and Results

This is a single-center study comparing mode of delivery, pregnancy outcome, indications for Caesarean section and induction of labor between women with and without CHD. A historical cohort study was conducted including 116 patients with CHD. An individual threefold matching with 348 women without CHD was carried out. Caesarean section was performed in 46.6% of pregnancies with CHD 33.6% without CHD, P = 0.012. Primary Caesarean section increases with severity of CHD P = 0.036, 33.3% of women with CHD had primary planned Caesarean section due to cardiac reasons. Induction of labor was performed in 45.7% of attempted vaginal deliveries in women with CHD 27.9% without CHD, P = 0.001. Lower mean birth weight P = 0.004 and Small for Gestational Age SGA P < 0.001 were more common in women with CHD. One CHD patient suffered from postpartum hemorrhage.

Conclusions

Concerns about maternal deterioration resulting in higher rates of induction of labor seem unjustified in most cases. Along with a possible reduction of Caesarean section on maternal request, a reduction of planned vaginal delivery may be expedient in reducing the rate of Caesarean section in women with CHD.



Autor: Joris Hrycyk, Harald Kaemmerer, Nicole Nagdyman, Moritz Hamann, KTM Schneider, Bettina Kuschel

Fuente: http://plos.srce.hr/



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