The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

Background/Aims Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications. Methods Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories’ clinical outcomes. Results This maternal cohort’s (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care. Conclusions Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score. Trial registration ACTRN12617000417381.

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Fetomaternal outcomes in pregnancy with different cardiac disease at a tertiary care center in Udaipur

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204003 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3983

Author(s):

Keerti Chaudhary ◽

Sangeeta Sen

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Gestational Age ◽

Cardiac Disease ◽

Systolic Function ◽

Tertiary Care ◽

Mode Of Delivery ◽

Cardiac Complications ◽

Cardiac Diseases ◽

In Pregnancy

Background: The incidence of maternal cardiac diseases has an adverse effect on pregnancy outcomes. The present study was done the objective to determine the Incidence and distribution of cardiac disease in pregnant patients, to assess mode of delivery and fetomaternal outcome in pregnancy with heart disease patients.Methods: This was a hospital based prospective observational study that include 65 pregnant women with diagnosed cardiac disease or had symptoms and signs suggestive of cardiac disease during the period from January 2018 to December 2019. Baseline data recorded including age, parity, gestational age, cardiac lesions, New York heart association (NYHA) functional class, use of cardiac medications, thorough clinical examination including chest and cardiovascular auscultation, ECG and echocardiographic assessment of left and right ventricular systolic function. Fetomaternal outcome was analysed in the study.Results: The mean age of the patients was 24.33±2.93 years (ranging from 19-36 years). 34 patients (52.30%) were primigravida. Majority (58.46%) cases were from rural area. Majority patients (70.77%) are present between 37-40 weeks of gestational age. Most of patients had vaginal delivery (64.62%). 43 patients (66.15%) diagnosed with heart disease after pregnancy, while 22 patients (33.85%) are diagnosed before pregnancy for heart disease. Neonatal complications were seen in in 35.38% of patients. Cardiac complications were present in 40% of patients. majority of fetal complications are in nonoperated patients (46.15%).Conclusion: The management of pregnant women with cardiac diseases requires multidisciplinary approach to prevent morbidity and mortality. It is necessary to optimize healthcare facilities to obtain maximum maternal and fetal outcome.

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Characteristics shifting of heart disease in pregnancy: A report from low middle-income country

Journal of Public Health Research ◽

10.4081/jphr.2021.2137 ◽

2021 ◽

Author(s):

Cyntia Puspa Pitaloka ◽

Absa Secka ◽

Ernawati Ernawati ◽

Agus Sulistyono ◽

Hermanto Tri Juwono ◽

...

Keyword(s):

Developing Countries ◽

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Cardiac Complications ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Acquired Heart Disease ◽

Heart Disease In Pregnancy ◽

In Pregnancy

Background: Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country.Design and methods: A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding their gestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameters, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups.Results: The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD.Conclusion: Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.

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Maternal Attitude and Knowledge towards Modes of Delivery

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i2.1225 ◽

2018 ◽

Vol 16 (2) ◽

pp. 209-214

Author(s):

Anshumala Joshi ◽

Meeta Thapa ◽

Om Biju Panta

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Caesarean Delivery ◽

Care Center ◽

Tertiary Care ◽

Mode Of Delivery ◽

College Teaching ◽

Cross Sectional ◽

Medical College ◽

Acceptable Method

Background: Whether a mother should be allowed to choose between the modes of delivery is a matter of concern among practicing obstetricians. This study aims to explore the knowledge of the Nepalese women attending a tertiary care center about the benefits and complications of vaginal and caesarean delivery and their attitude and preference for the method of delivery.Methods: The study was a hospital based cross sectional questionnaire survey conducted in Nepal Medical College teaching Hospital, Jorpati from 1stShrawan 2074 to 31st Ashoj 2074. All pregnant women who were 36 weeks or more in gestation attending the clinic during the study period were included in the study. A questionnaire was made of 10 questions for knowledge assessment regarding mode of delivery consisting of the indications, the possible complications and advantages of vaginal and caesarean delivery. Results: A total of 256 pregnant women participated in the study. The knowledge of the mode of delivery, their benefit and complications was medium to good in approximately 90% of the mothers attending the antenatal OPD. Overall attitude for vaginal delivery was positive in 93% of women and negative or neutral in 6.6%.Overall attitude for caesarean delivery was positive in 24% and negative or neutral in 75.8%.Conclusions: Women in our setup agree that vaginal delivery is a natural and acceptable method of delivery and would prefer to have a vaginal delivery. Keywords: Attitude; knowledge; modes of delivery; women.

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Study of spectrum of cardiac disease complicating pregnancy and the maternal and foetal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195324 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4803

Author(s):

Sudha R. ◽

Anjali R.

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Heart Diseases ◽

Cardiac Complications ◽

Team Approach ◽

Maternal Deaths ◽

Neonatal Deaths ◽

Foetal Outcome ◽

Grade Iii

Background: Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy, accounting for almost 10% of maternal deaths. They complicate 1-3% of all pregnancies.Methods: The study was conducted at Cheluvamba Hospital from January 2015 till July 2016. All pregnant women with cardiac disease were included in the study. Pregnant women with cardiac disease were followed up during antenatal period, evaluated and maternal and foetal outcome was studied.Results: Total number of deliveries in the one and half year study period was 18,803 cases and the total number of women with cardiac disease was 90. Most of the subjects belonged to NYHA grade I and II (95.5%), whereas NYHA grade III and IV constituted only 4.4% of cases. Rheumatic heart disease was the principal cardiac lesion (62.22%) among the pregnancies, while congenital heart disease (33.33%) was the second most common cause. 16.7% had cardiac complications and there were 2(2.22%) maternal mortality. 91.86% were live births with 5.88% IUDs and 2.35% neonatal deaths. 15.29% of the babies were Preterm, 8.14% were IUGR babies and 2.35% had congenital anomalies. It was noted NYHA grade III/IV cases had more preterm babies compared to NYHA grade I/II. NICU admissions were also more with NYHA grade III/IV.Conclusions: The results suggest the need for pre-pregnancy counselling, early diagnosis, correction of cardiac lesions where indicated, close surveillance during pregnancy and a team approach comprising of obstetricians, cardiologists, neonatologists and nursing personnel for a successful pregnancy outcome.

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Impact of Cardiomyopathy on Clinical Outcomes in Pregnant Women with Heart Disease

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2013.06.117 ◽

2013 ◽

Vol 19 (8) ◽

pp. S35

Author(s):

Nicholas Bope ◽

Jawad Shahid ◽

Paraskevi Koutrolou-Sotiropoulou ◽

Charles Miller ◽

Puja Parikh ◽

...

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Clinical Outcomes

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A cross-sectional study to determine the use of alternative medicines during pregnancy in the district hospitals in Manicaland, Zimbabwe

African Health Sciences ◽

10.4314/ahs.v20i1.11 ◽

2020 ◽

Vol 20 (1) ◽

pp. 64-72

Author(s):

Liphapang Dimene ◽

Mutseyekwa Fadzai ◽

Jephat Chifamba ◽

Gerald Nyakatawa ◽

Carol Mahachi ◽

...

Keyword(s):

Pregnant Women ◽

Traditional Medicine ◽

Family Income ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Traditional Medicines ◽

District Hospitals ◽

Medicines Use

Background: Traditional medicines are widely used in the rapidly growing health system and are of economic importance. The study aimed at determining the frequency, pattern of use and factors that influence traditional medicines use during pregnancy. Materials and methods: A cross-sectional study was carried out at four district hospitals in Manicaland, Zimbabwe, using questionnaire based convenience sampling. Results: Traditional medicines use was found to be high with 54% (n = 337) of pregnant women using traditional medicines during pregnancy. The major purpose of use of traditional medicine was found to be preparation for delivery; cervical dila- tion in particular. The following factors showed a significant statistical association for use of traditional medicines: previous mode of delivery (p = 0.006), level of education (p = 0.016), family income (p = 0.007), and residential settlement (p = 0.026). Some of the common traditional medicines used during pregnancy include Camellia sinensis, Aloe, Spirostachys Africana, Thumbergia lancifolia, Dalbergiella nyasae, Steganotaenia oraliacea, Stomatostemma monteiroae and Cussonia arborea. Conclusion: A number of pregnant women use traditional medicines as partus preparators (labour aids) throughout the entire pregnancy period. This calls for obstetricians, general practitioners and midwives to inquire about use of traditional medicine in history. Keywords: Traditional medicines; pregnancy; Zimbabwe.

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Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

10.21203/rs.3.rs-285815/v1 ◽

2021 ◽

Author(s):

Caleb Chun Wei Lim ◽

Marlene Samantha Sze Minn Goh ◽

Ka-Hee Chua ◽

Meei Jiun Seet ◽

Siew Guek Tay ◽

...

Keyword(s):

Pregnant Women ◽

Best Practice ◽

Perinatal Care ◽

Mode Of Delivery ◽

In Utero ◽

Neonatal Care ◽

Prevention Strategies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

Abstract Background: This study aimed to investigate the knowledge and expectations of pregnant women on perinatal and neonatal care during the coronavirus disease 2019 (COVID-19) pandemic in Singapore. Methods: A cross-sectional survey was administered to pregnant women attending antenatal clinics between August and September 2020 via a secure online platform. Participants aged ≥21 years without a history of confirmed COVID-19 were included. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic. Results: A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4; range 22-43 years). The median gestational age was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. There was no significant association between the sociodemographic factors evaluated and maternal agreement with the possibility of in-utero SARS-CoV-2 transmission and the risk associated with vaginal delivery in women with COVID-19. Although 46% of participants were concerned about the increased risk of contracting COVID-19 during routine clinic appointments, only 37% of the cohort were agreeable with teleconferencing of clinic appointments. More than half (56%) of the participants reported that their postnatal confinement plans were affected by the current pandemic. Conclusions: Our survey revealed that majority of participants were aware of modes of transmission, prevention strategies and in utero transmission of SARS-CoV-2. Significant gaps were identified in their knowledge related to method of delivery and safety of breastfeeding, along with significant variability to the agreement with alterations to the perinatal care. For best practice we recommend provision of evidence-based information early to expectant mothers by the healthcare professionals to reduce misinformation and anxiety amongst pregnant women.

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Fetomaternal Outcome in Pregnancy With Cardiac Disease

Journal of Chittagong Medical College Teachers Association ◽

10.3329/jcmcta.v23i1.51892 ◽

2012 ◽

Vol 23 (1) ◽

pp. 31-35

Author(s):

Shahanaj Sharmin ◽

Shahanara Chowdhury ◽

Didarul Alam ◽

Mohiuddin Ahmed ◽

Fahamida Rashid ◽

...

Keyword(s):

Heart Disease ◽

Birth Weight ◽

Pregnant Women ◽

Rheumatic Heart Disease ◽

Cardiac Disease ◽

Cross Sectional Study ◽

Normal Vaginal Delivery ◽

College Hospital ◽

Cross Sectional ◽

Rheumatic Heart

Aim of our study was to see the maternal and fetal outcomes in women presenting with heart disease during pregnancy and labout. This cross sectional study was carried out in 48 pregnant women with cardiac disease from July 2005 to Dec 2006, in the department of Gynae and Obst at Chittagong Medical College Hospital Chittagong. The Mewan age was 25.40 ±4.46 years. 31(64.6%) patients were from middle class. 27 (56.3%) patients belonged to mulliparous group. 33(68.8%) patients received regular antenatal care, of the 43 (89.7%) patients had rheumatic heart disease and 5(10.5%) had congenital heart disease. Among the rheumatic heart disease, 50% had mitral stenosis. 35(72.9%) patients had in grade-1, 12(25%) had in grade-II, and 1(2.1%) had in grade-III. (64.5%) had normal vaginal delivery, 7(14.5%) had LSCS. 4(8.3%) had heard failure and 1 patient (2.1%) expired due to heart failure, 40(83.3%) were delivered at term, 7(14.6%) had preterm labour and 1(2.1%) had still birth. Regarding birth weight, 17(35.4%) had LBW (Low birth weight), 31(64.6%) had normal birth weight. Rheumatic heart disease is the commonest cardiac lesion among Pregnant women. Fetomaternal morbidity and mortality are strongly correlated with maternal cardiac functional classification. The management of these cases should be multidisciplinary to optimize care of these patients. JCMCTA 2012; 23(1): 31-35

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Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

Obstetric Medicine ◽

10.1177/1753495x15625547 ◽

2016 ◽

Vol 9 (2) ◽

pp. 78-82

Author(s):

NM Murphy ◽

AS Khashan ◽

DI Broadhurst ◽

O Gilligan ◽

K O’Donoghue ◽

...

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

D Dimer ◽

In Pregnancy

Background To examine perinatal determinants of the antenatal levels of D-dimers. Methods Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. Results D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past ( P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women ( P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset ( P = 0.003) and induction of labour ( P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery ( P = 0.008) and instrumental vaginal delivery ( P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section ( P = 0.008). Discussion There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

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Ease of understanding and performing HIV self-tests by pregnant women and their male partners in Uganda: a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462420983935 ◽

2021 ◽

pp. 095646242098393

Author(s):

Kisa Rose ◽

Joseph KB Matovu ◽

Caroline J Vrana-Diaz ◽

Esther Buregyeya ◽

Joseph Kagaayi ◽

...

Keyword(s):

Pregnant Women ◽

Mode Of Delivery ◽

Male Partner ◽

Cross Sectional Study ◽

Education Level ◽

University Education ◽

Male Partners ◽

Cross Sectional ◽

Cluster Randomized ◽

Promotional Messages

Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical step in the use of HIVST kits. We analyzed data on pregnant women and their partners’ self-assessment on the usability of kits delivered by their pregnant women. Methods: Quantitative data were collected on 399 pregnant women and 238 male partners enrolled in the intervention arm of a large cluster-randomized HIVST trial. Each pregnant woman received HIVST demonstrations, detailed pictorial instructions on how to use OraQuick HIVST kits, and two kits; for herself and her male partner. Follow-up was at one month (baseline for male partners) and 3 months. Descriptive statistics were conducted to compare understanding and following of HIVST instructions by age and education level. Results: The proportion of those who understood HIVST instructions was almost the same (98%) for women and their partners, although partners (26.5%) were nearly twice as likely than women (16.0%) to report needing pretest counseling (Odds ratio [OR] = 1.9, 95% CI: 1.27–2.79). Partners’ understanding of the HIVST instructions did not vary by education level, but 4.4% of women with primary education reported difficulty in understanding HIVST instructions compared with 0.5% and 0% of those with secondary and university education, respectively ( p = 0.05). However, 5.6% of women aged 30–68 years and 3.3% of partners aged 20–24 years found it more difficult to understand the HIVST instructions. Conclusion: Both pregnant women and their male partners were correctly able to perform an HIVST without or (with minimal) support suggesting that this mode of delivery will help the national program reach more men. Because more male partners than women required HIVST pretest counseling support, male-targeted HIVST promotional messages may be needed to increase men's self-efficacy to perform HIVST unsupported.

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