Pregnancy Mortlaity
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Pregnancies in women with pre-existing cardiomyopathies are considered at high risk for complications. This study evaluates the prevalence and predictors of acute cardiac and obstetric events in women with a cardiomyopathy during pregnancy. Cardiomyopathies are defined by structural and functional abnormalities of the ventricular myocardium (heart muscle). In pregnancy there is increased hemodynamic demand. This demand may not be met in mothers with pre-existing cardiomyopathy by physiological adaptations. For such populations, various scoring systems have been proposed for prediction of complications during pregnancies, such as the Carpreg and Zahara scores and the modified World Health Organization (WHO) risk score. This article concludes by stating that the Carpreg score is the most appropriate predictor of maternal complications.
(Prathamesh Prabhudesai)
References
Callaghan, W. M. (2012, 02). Overview of Maternal Mortality in the United States. Seminars in Perinatology, 36(1), 2-6. doi:10.1053/j.semperi.2011.09.002
This article gives an overview of the different causes of pregnancy related mortality. They include haemorrhage, thrombotic pulmonary embolism, amniotic fluid embolism, infection, cardiomyopathies, hypertension, anesthesia, cardiovascular conditions and non cardiac conditions. Death because of hemorrhage was the leading cause earlier and accounted for > 25%. While it still remains one of the major causes, its role in proportion of all deaths has decreased. This can be because of the significant increase in deaths due to cardiomyopathies and pre-existing medical conditions, especially those of cardiac origin. The rise of cardiac conditions in women can be attributed to the well-documented increase in diabetes, hypertension and obesity women becoming pregnant in the later years of reproductive life.
Siu, S. C., Sermer, M., Colman, J. M., Alvarez, A. N., Mercier, L., Morton, B. C., . . . Sorensen, S. (2001, 07). Prospective Multicenter Study of Pregnancy Outcomes in Women With Heart Disease. Circulation, 104(5), 515-521. doi:10.1161/hc3001.093437
This multicenter study provides an assessment of maternal and neonatal risk associated with pregnancy in women with heart disease who are receiving comprehensive prenatal care. It concludes by stating that pregnancy in women with diseases of cardiac origin is associated with significant maternal and neonatal complications, despite state-of-the-art obstetric and cardiac care. The study showed that 13% of women with underlying cardiac condition presented with a cardiac event. Poor New York Heart Association class, cyanosis, myocardial dysfunction, prior arrhythmia, and prior heart failure/stroke were identified and quantified as risk factors for maternal cardiac events.
Ghulmiyyah, L., & Sibai, B. (2012, 02). Maternal Mortality From Preeclampsia/Eclampsia. Seminars in Perinatology, 36(1), 56-59. doi:10.1053/j.semperi.2011.09.011
Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. It is a condition that affect women with underlying hypertension. Majority of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management. This problem can be solved by early detection of hypertension in pregnancy. Preeclampsia is a syndrome in which there is new onset of hypertension and protein excretion in urine after 20 weeks of gestation in women who didn’t have hypertension earlier. Eclampsia is the development of grand seizures in a woman with gestational hypertension or preeclampsia. HELLP syndrome is one of the complications of this and contributes to a very high mortality.
Yost, G., Collofello, B., Goba, G., Koch, A., Harrington, A., Esmailbeigi, H., . . . Dobiesz, V. (2017, 08). A novel obstetric medical device designed for autotransfusion of blood in life threatening postpartum haemorrhage. Journal of Medical Engineering & Technology, 41(7), 515-521. doi:10.1080/03091902.2017.1364308
Postpartum haemorrhage (PPH) is an obstetric emergency commonly defined as a cumulative blood loss of 500 ml or more within 23 h after birth. In late pregnancy, there is increased blood flow to the uterus nearing 700 ml/min. Due to this if there is any structural damage during delivery, it can lead to massive blood loss. In a normal delivery, bleeding is stopped by contraction of muscles and by clotting factors. In abnormal conditions, this bleeding can result in anemia, hypovolemic shock and death. Mortality subsequent to obstetric haemorrhage is a leading cause of maternal mortality, but yet remains a largely unpreventable complication of childbirth. Without access to proper medical treatment and a safe blood supply, PPH disproportionately affects women in low-resource settings. The treatment for PPH focuses on hemostasis and achieving hemodynamic stability rapidly. Current strategies for control of PPH in low resource settings include use of condom tamponade, non-pneumatic anti-shock garments (NASG) and active management of third stage labour often by using sublingual misoprostol.
Billebeau, G., Etienne, M., Cheikh-Khelifa, R., Vauthier-Brouzes, D., Gandjbakhch, E., Isnard, R., . . . Charron, P. (2017, 11). Pregnancy in women with a cardiomyopathy: Outcomes and predictors from a retrospective cohort. Archives of Cardiovascular Diseases. doi:10.1016/j.acvd.2017.05.010
Pregnancies in women with pre-existing cardiomyopathies are considered at high risk for complications. This study evaluates the prevalence and predictors of acute cardiac and obstetric events in women with a cardiomyopathy during pregnancy. Cardiomyopathies are defined by structural and functional abnormalities of the ventricular myocardium (heart muscle). In pregnancy there is increased hemodynamic demand. This demand may