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#Grand Rounds

Heart Disease in Pregnancy: When to Deliver

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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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