P5353Pregnancy in congenital heart disease - risk stratificaton
Abstract Introduction Maternal congenital heart disease is a leading cause of peripartum maternal mortality, which is also associated with increased risk of fetal morbidity and mortality. We aimed to provide risk stratification for congenital heart disease patients using the recently introduced CARPREG (Cardiac Disease in Pregnancy) II score at our Institute. Patients and methods We enrolled 191 pregnant women with congenital heart disease (mean age at pregnancy 29.2±5,7 years). We recorded all foetal (premature birth, abortion, congenital heart abnormalities) and maternal (postpartum heart failure, stroke, hypertension) events in 276 pregnancies. High-risk pregnancy was defined as a CARPREG II score of 4≤. Results High-risk pregnancy was detected in 14.1%. We found fetal and maternal events in 13.8% and 14.5% of all pregnancies, respectively, which both were more prevalent in the high-risk group (p<0.001). No maternal death occurred, whereas premature birth and abortion was detected in 7.6 and 2.9%, respectively, both complications were more frequent in the high-risk patient population as compared to the lower risk patients (30.8 vs. 7.2%, p<0.001). In univariate analysis, CARPREG II of 4≤ was significantly associated with fetal (p<0.001, OR: 4.2) and maternal (p<0.001, OR: 5.3) events. Risk factors of the CARPREG II were further analyzed using multivariate logistic regression analysis: prior cardiac events or arrhythmias (p=0.027) and cyanosis (p=0.026) were independent predictors of fetal complications. Left ventricular outflow tract obstruction (p<0.001), cardiac interventions (p=0.024) and prior cardiac events or arrhythmias (p=0.001) demonstrated significant association with maternal events. Conclusion The CARPREG II could help in the identification of high-risk pregnancies and thus aids the selection of patients for strict monitoring and special therapies. In line with previous studies we detected higher rates of fetal and maternal events among patients with CARPREG II of 4≤ score.