BACKGROUND AND PURPOSE:

• There is limited data regarding the optimal delivery time for pregnant women with cardiovascular disease (CVD)
• Rouse et al. (American Journal of Perinatology, 2020) examined maternal outcomes in women with CVD who delivered in the early term period vs ≥39 weeks

METHODS:

• Prospective cohort study (between 2001 and 2016)
  • Standardized Outcomes for Reproductive Cardiovascular Care (STORCC) trial
• Participants
  • Pregnant women with CVD
  • Delivery ≥37 weeks
• Study design
  • The authors examined the associations between gestational age at delivery and perinatal characteristics
  • Cohorts: Early term (37w0d to 38w6d) vs term (≥39w0d)
• Primary outcome
  • Composite cardiac outcome included ≥1 of the following: Congestive heart failure | Arrhythmia | Cerebrovascular event | Valvar dysfunction | Endocarditis | Aortic dissection | Need for cardiac intervention | Cardiac arrest | Cardiac death
  • Composite outcome must occur in peripartum or postpartum period (within 6 weeks of delivery) | Not present at delivery

RESULTS:

• 225 women
  • Early term deliveries: 37%
  • Term deliveries: 63%
• The early term group had significantly higher rates of
  • Any hypertension during pregnancy (P = 0.01)
    • Early: 18.1%
    • At term: 7%
  • Intrauterine growth restriction (P < 0.001)
    • Early: 22.9%
    • At term: 2.8%
• There was no difference in the primary outcome between groups
  • Composite cardiac morbidity (P = 0.24)
    • Early: 4.8%
    • At term: 3.5%
• Women in the early term group were more likely to undergo cesarean delivery than women in the term group (P = 0.004)
  • Early: 43.4%
  • At term: 24.7%

CONCLUSION:

• For women with stable CVD, there is no cardiac benefit to delivery prior to 39 weeks
• The authors state

Our findings lend support to existing guidelines suggesting that an early term delivery confers no maternal benefit in asymptomatic women with CVD and no other indication for a 37- or 38-week delivery

Whether the maternal benefits of elective delivery at term hold true for mothers with CVD remains to be seen and is an area for future research

Learn More – Primary Sources:

Timing of Delivery in Women with Cardiac Disease

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