Cardiac disease in pregnancy risk factors
|
Cardiac disease in pregnancy Microchapters |
|
Diagnosis |
|---|
|
Catheterization: |
|
Treatment |
|
Special Scenarios:
|
|
Cardiac disease in pregnancy risk factors On the Web |
|
American Roentgen Ray Society Images of Cardiac disease in pregnancy risk factors |
|
Directions to Hospitals Treating Cardiac disease in pregnancy |
|
Risk calculators and risk factors for Cardiac disease in pregnancy risk factors |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor In Chief:
Overview
Women with acquired or congenital heart disease have a higher risk of cardiac complications during pregnancy than the general population. In general, a full evaluation including history, physical examination, echocardiogram, and electrocardiogram should be considered for these patients. Further risk stratification and monitoring are determined by a number of factors, including the prior cardiac events, the presence of heart failure, valvular disease, and systolic or diastolic dysfunction.
Risk Factors Associated with Maternal Cardiovascular Disease
A prospective study performed by Siu and colleagues identified four predictors of maternal cardiac events.[1] These include:
- A prior cardiac event (e.g., heart failure, transient ischemic attack, or stroke before pregnancy) or arrhythmia
- A baseline New York Heart Association (NYHA) class higher than Class II or cyanosis
- A left-sided heart obstruction (mitral valve area smaller than 2 cm2, aortic valve area less than 1.5 cm2, or peak left ventricular outflow tract gradient more than 30 mm Hg by echocardiography
- Reduced systemic ventricular systolic function (ejection fraction less than 40%)
Based on this study of approximately 600 patients, the estimated risk of a cardiac event in pregnancies with 0, 1, and more than 1 point was 5%, 27%, and 75%, respectively. The authors recommended that those with a low cardiac risk of 0 could safely be delivered in a community hospital, but those at intermediate or high cardiac risk (risk score of 1 or more) should be delivered at a regional center.