scholarly journals A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

2021 ◽  
Vol 10 (4) ◽  
pp. 1637
Author(s):  
Khushboo Goel ◽  
Sanjaykumar G. Tambe
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Observational Study ◽  
Maternal Mortality ◽  
Prospective Observational Study ◽  
Neonatal Outcome ◽  
Risk Group ◽  
High Risk Group ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Background: Prevalence of heart disease in pregnancy vary from 0.3-3.5%. Normal pregnancy is associated with physiological cardiovascular changes. These changes may unmask underlying cardiac disease in normal women and increase morbidity and mortality in women with heart disease. Heart disease in pregnancy is an important cause of maternal mortality in India. The aim of this study was to evaluate the maternal and neonatal outcome of pregnancy with heart disease.Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India. 75 patients who fulfilled the inclusion criteria were studied. Maternal and neonatal outcome were analyzed.Results: Maternal heart disease was classified into congenital (36%) and acquired (64%). In acquired variety, rheumatic heart disease was most commonly seen. In congenital, ASD was most common. We divided the cases into two groups based on their NYHA status, low risk group had 74.67% patients and high risk group had 25.33% patients. The most common antenatal complication was PROM (41.3%). There was statistically significant association between ICU admission and high-risk group. The most common neonatal complications were IUGR and prematurity. Maternal mortality rate in the study group was 6.6%.Conclusions: The perinatal outcome of heart disease in pregnancy is more dependent on the severity of symptoms rather than the duration and type of heart disease. Multidisciplinary evaluation is necessary. Suboptimal optimization of the heart condition in the antenatal period and delayed referral were the major risk factor for maternal mortality. 

Abstract 2126: Twoaces (tia Work-up Asoutpatient: Assessment Of Clincal Efficacy And Safety)

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jenifer Green ◽  
Connie Wolford ◽  
Jean Marc Olivot ◽  
Gregory Albers ◽  
James Castle
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Stroke Rate ◽  
Significant Stenosis ◽  
Non Invasive ◽  
Low Rate ◽  
Arterial Imaging

Background: Much controversy exists as to which TIA patients need to be admitted to the hospital for evaluation and treatment and which can be sent home. One commonly used trigae tool is the ABCD 2 score (Age, presenting Blood Pressure, Clinical symptoms and Duration, and Diabetes). Although this tool gives good information for determining populations at low risk (score of 0-3) and high risk (score of 6-7) of stroke after TIA, it leaves a large moderate risk population (score of 4-5) for whom no clear triage guidance can be given. As previous studies have found large artery atherosclerosis to be a potent risk factor for stroke after TIA, we attempted to further delineate low and high risk TIA populations with the addition of non-invasive arterial imaging to the ABCD 2 score. Methods: All patients referred to the Stanford Stroke Service for possible TIA within 72 hrs of symptom onset between July 2007 and February 2010, and all patients referred to the Highland Park Stroke Service for possible TIA within 72 hrs of symptom onset after October 2009 were screened for enrollment in this observational study. Exclusion criteria included age <18 years, use of TPA at initial presentation, and symptoms lasting >24 hours. 352 patients were invited to enroll, 3 refused. Of the 349 enrolled, follow-up was obtained in 346 patients at 30 days. Patients were placed into two groups: 1) those with ABCD 2 scores of 0-3 or scores of 4-5 AND no sign of hemodynamically significant stenosis in an artery within the distribution of the TIA (Low Risk Group); and 2) those with ABCD 2 scores of 6-7 or scores of 4-5 AND a hemodynamically significant stenosis in an artery within the distribution of the TIA (High Risk Group). Non-invasive arterial imaging included CT angiogram, MR angiogram, and carotid ultrasound - all used at the discretion of the treating physician. 30 day stroke rates with 95% confidence intervals were recorded. Results: Of the 346 patients enrolled, 295 (85.3%) fell into the "Low Risk Group" based on ABCD 2 scoring and non-invasive arterial imaging. Within that group, the stroke rate at 30 days was 1.0% (3 strokes, 95% CI 0.2-3.1%). Within the "High Risk Group", the stroke rate at 30 days was 5.9% (3 strokes, 95% CI 1.4-16.5%). Within the "Low Risk Group", all 3 of the strokes occurred in patients with ABCD 2 scores of 4-5 (3/133 patients - 2.3% stroke rate with 95% CI 0.5-6.7%). The overall stroke rate was 6/346 (1.7%, 95% CI 0.7-3.8%). Conclusions: In our observational study we found that the overall 30 day stroke rate after TIA was quite low. The percentage of all TIA patients falling into the “Low Risk Group” was quite high, and these patients had a particularly low rate of stroke at 30 days. Given the high number of "Low Risk" patients and the low rate of stroke in that group at 30 days, the vast majority of TIA patients could likely be safely evaluated in an rapid outpatient setting provided that the treating physician is confident of the diagnosis.

scholarly journals ADOLESCENTS WITH CONGENITAL HEART DISEASE: A HIGH RISK GROUP

2016 ◽  
Vol 67 (13) ◽  
pp. 1012
Author(s):  
Aparna Kulkarni ◽  
Patricia Zybert ◽  
Shelby Kutty ◽  
Richard Neugebauer ◽  
Brett Anderson
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
Risk Group ◽  
High Risk Group

scholarly journals Immune Thrombocytopenic Purpura in Pregnancy- A Prospective Observational Study in a Tertiary Care Centre

2019 ◽  
Vol 34 (1) ◽  
pp. 15-21
Author(s):  
Tabassum Parveen ◽  
Firoza Begum ◽  
Nahreen Akhter ◽  
Nigar Sultana ◽  
Khairun Nahar
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Observational Study ◽  
Immune Thrombocytopenic Purpura ◽  
Platelet Transfusion ◽  
Prospective Observational Study ◽  
Thrombocytopenic Purpura ◽  
Neonatal Thrombocytopenia ◽  
Itp In Pregnancy ◽  
In Pregnancy

Objectives: Immune thrombocytopenic purpura (ITP) in pregnancy necessitates management of two patients, the mother and the newborn. Complications like maternal bleeding, fetal and neonatal thrombocytopenia demands appropriate and timely therapy. This prospective observational study was designed to explore and summarize the current approach to the investigation, diagnosis, management and outcome of ITP in pregnancy. Materials and Methods: Women with ITP admitted in the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2009 -2017, were included in the study. Total number of high risk pregnancy during that period were 7704 among them 20 cases were pregnancy with Immune Thrombocytopenic Purpura (ITP). Patients were managed under joint supervision of the fetomaternal medicine specialist and the hematologist. Prednisolone was considered as a first line drug in management protocol. Platelet transfusion was considered if there were symptoms or count <20X109/L at any stage of pregnancy or <50 X109 / L in late pregnancy without symptoms. Platelet count of newborn was performed at birth and repeated on day four and count<150X109/L was considered as neonatal thrombocytopenia. Results: Frequency of ITP among high risk patients was found 2.5/1000 live birth, most were preexisting (75%). Almost all cases (95%) were treated with prednisolone. Commonest clinical presentations were gum bleeding (70 %) and purpuric rashes (60%). Though during pregnancy, severe thrombocytopenia (<50 X109/L) was found in 7 patients (35%) but none was at the time of delivery, as drugs and/or platelet transfusion was considered to make delivery process safe. Platelet transfusion needed in 77.7% cases in a range of 1-75 units. Primary PPH noted in 3 cases (17%), increased bleeding during surgery in 5 patients (33%) and one patient needed ICU support. Neonatal thrombocytopenia noted in 5 cases (28%). Though 2 of the neonates needed NICU admission but none needed platelet transfusion and all the babies were discharged healthy. Conclusion: This study documents that pregnancy with ITP need close monitoring, require agents to raise the platelet count and repeated platelet transfusion to maintain reasonable safe platelet count. There are chances of PPH, capillary oozing during surgery. However good outcome is possible for most women, fetus and neonates with appropriate and timely therapy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 15-21

scholarly journals Study of heart disease in pregnancy and its effect on maternal outcome

2019 ◽  
Vol 8 (8) ◽  
pp. 3031
Author(s):  
Nitin Kumar Jain ◽  
Shabana Sultan
Keyword(s):  
Heart Disease ◽  
Maternal Mortality ◽  
Heart Diseases ◽  
Functional Class ◽  
Maternal Outcome ◽  
Class Iii ◽  
Nyha Functional Class ◽  
Number Of Patients ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Background: Heart diseases in pregnant women and has higher incidence of maternal mortality and morbidity and is regarded as risk factor for unfavourable outcome of pregnancy both for the mother and the foetus. Heart disease in pregnancy was found to be second indirect cause contributing to maternal mortality in India.Methods: This study is a hospital based prospective analytical study carried out in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal over a period of 1 year from 1st March 2017 to 28th February 2018. Patients were evaluated clinically by both obstetrician and cardiologist and followed all through their hospital stay till discharge.Results: Total 51 cases of heart disease were found during the study period. Incidence of heart disease in our study during study period was found 0.25%. Most patients were unbooked 33(64.71%) and maximum number of patients belonged to NYHA functional class II 24 (47.06%), RHD cases were 4 times more common than CHD. 24 (47.06%) patients had undergone surgical intervention for heart disease. Congestive cardiac failure was most common complication seen. Three maternal deaths were seen. All cases belonged to NYHA functional class III. All 3 cases were unbooked presented first time in labor.Conclusions: We found that pregnancy outcome was good in booked cases with regular checkup by obstetrician and cardiologist, surgically corrected cases and those with NYHA functional class I and II. Hence, joint management by obstetrician, cardiologist, and anesthetist is required to ensure better maternal outcome.

scholarly journals ASUHAN KEBIDANAN CONTINUITY OF CARE PADA NY.K MASA HAMIL SAMPAI DENGAN KELUARGA BERENCANA DI KLINIK PANGESTU POLOREJO 2

2018 ◽  
Vol 2 (2) ◽  
pp. 83
Author(s):  
Siti Qomariyah ◽  
Suharti Suharti ◽  
Inna Sholicha Fitriani
Keyword(s):  
Family Planning ◽  
High Risk ◽  
Infant Mortality ◽  
Maternal Mortality ◽  
Continuity Of Care ◽  
Postpartum Period ◽  
Risk Group ◽  
Home Visits ◽  
High Risk Group ◽  
Midwifery Care

AbstractOne effort to reduce maternal mortality (MMR) and infant mortality (IMR) is by placing one midwife in each village with the responsibility of 1000 people in the region. Another way to deal with MMR and IMR problems is to provide comprehensive (comprehensive) midwifery care or care on a continuity of care basis starting from pregnancy, childbirth, childbirth, newborns and family planning.The care provided to Ny.K G3P20002 at 38 years of age has been conducted for pregnancy examinations 2 times at 39 4/7 weeks. From the results of the study, the mother complained of having fake her, constipation, hypertension and anxiety. Mother underwent delivery process at 41 41/7 weeks through surgery (SC) with indications postdate. PNC visits were carried out 3 times with normal examination results (including ttv, lokhea, involution, and lactation) on a 6-week visit, the mother complained of constipation. Babies are born through the SC process on March 1, 2018 weighing 3000 grams and on the last visit BB infants became 3900 grams. Babies experience physiological jaundice during the 6th day visit. Mother has participated in MOW after the SC action and home visits were made on the 20th day of March 20, 2018.Overall, mothers are included in the high risk group (HRG) with a score of 10 KSPR. In the postpartum period, in newborns and family planning there are no problems that can endanger both and are still classified as physiological.Keywords: Care provided, continuity of care, pregnancy periode, family planning Abstrak Salah satu upaya dalam menekan angka kematian ibu (AKI) dan angka kematian bayi (AKI) adalah dengan cara penempatan 1 bidan di setiap desa dengan tanggung jawab 1000 masyarakat di wilayah tersebut. Cara lain dalam menangani masalah AKI dan AKB adalah dengan cara memberikan asuhan kebidanan yang menyeluruh (komprehensif) atau asuhan secara continuity of care dimulai dari masa hamil, bersalin, nifas, bayi baru lahir serta KB.Asuhan yang diberikan pada Ny.K G3P20002 usia 38 tahun telah dilakukan pemeriksaan kehamilan sebanyak 2 kali saat uk 39 4/7 minggu. Dari hasil pengkajian ibu mengeluh mengalami his palsu, konstipasi, hipertensi serta cemas. Ibu menjalani proses persalinan saat uk 41 4/7 minggu melalui tindakan operasi (SC) dengan indikasi postdate. Kunjungan PNC dilakukan 3x dengan hasil pemeriksaan normal (meliputi ttv, lokhea, involusi, dan laktasi) pada kunjungan 6 minggu ibu mengeluh konstipasi. Bayi lahir melalui proses SC pada tanggal 1 Maret 2018 dengan berat 3000 gram dan pada kunjungan terakhir BB bayi menjadi 3900 gram. Bayi mengalami ikterusfisiologis pada saat kunjungan hari ke-6. Ibu telah berpartisipasi dalam KB MOW pasca tindakan SC dan dilakukan kunjungan rumah pada hari ke-20 tanggal 20 Maret 2018.Secara menyeluruh ibu termasuk dalam kelompok resiko tinggi (KRT) dengan skor KSPR 10. Dalam masa nifas, pada bayi baru lahir serta KB tidak ada masalah yang dapat membahayakan keduanya dan masih tergolong dalam fisiologis.Kata kunci: Asuhan kebidanan, continuity of care, masa hamil, keluarga berencana

FETOMATERNAL OUTCOME OF PREGNANCY WITH HEART DISEASE IN A TERTIARY CARE HOSPITAL OF KOLKATA IN EASTERN INDIA

2021 ◽  
pp. 21-23
Author(s):  
Kajal Kumar Patra ◽  
Dipnarayan Sarkar ◽  
Sukhamoy Saha
Keyword(s):  
Heart Disease ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Care Hospital ◽  
Age Group ◽  
Normal Delivery ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

BACKGROUND: Heart disease in pregnancy is still a major problem worldwide, particularly in low resource country like India. Its reported incidence varies between 0.1 to 4%. Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the rheumatic heart disease (RHD) contributes to approximately 70% of heart disease seen in pregnancy. Heart disease in pregnancy is associated with adverse fetomaternal outcome and has re-emerged as one of the leading causes of maternal mortality. The maternal mortality rate in women with cardiac disease is 7% and morbidity is 30% during pregnancy in India. METHODS: This study was a prospective observational study conducted in the IPGMER & SSKM Hospital, Kolkata, West Bengal from December 2020 to February 2021. 36 Pregnant women with heart disease were taken as study group. Multiple pregnancy and any other medical disorder like GDM, PIH, were excluded from study. Fetomaternal outcome, mode of delivery, prematurity, LBW, NICU admission and maternal and neonatal mortality were compared. Template was generated in MS excel sheet and analysis was done on SPSS software. RESULTS: Among 36 patients 14 (38.89%) patients belonged to age group 25-29 years and 2 (5.56) belonged to age group <20 years. 13 (36.11%) patients belonged to lower middle class and 17 (47.22%) belong to lower class. 19 (52.78%) patients were P and 9 (25%) were P parity group. 20 (55.56%) belong to gravida G1. 10 (27.78%) 0+0 1+0 patients had CHD and RHD. 20 (55.56%) were normal delivery. 13 (36.11%) of babies were underweight. Maternal death were 2 (5.56%). CONCLUSIONS: Feto-maternal outcome can be improved appreciably by antenatal care, early diagnosis and management.

Abstract WMP61: TWOACES: TIA Work-up As Outpatient, Assessment Of Clinical Efficacy And Safety

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
James Castle ◽  
Jenifer Green ◽  
Jean-Marc Olivot ◽  
Gregory Albers
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Stroke Rate ◽  
Significant Stenosis ◽  
Non Invasive ◽  
Low Rate

Background: Much controversy exists as to the appropriate triage of acute TIA patients. One commonly used tool is the ABCD 2 score. This tool is helpful for patients at low risk (score of 0-3) or high risk (score of 6-7) of stroke, but leaves a large moderate risk population (score of 4-5) for whom no clear guidance can be given. As previous studies have found large artery atherosclerosis to be a potent risk factor for stroke after TIA, we attempted to further delineate low and high risk TIA populations with the addition of non-invasive arterial imaging. Methods: All patients referred to the Stanford Stroke Service for possible TIA within 72 hours of symptom onset between July 2007 and February 2010, and all patients referred to the Highland Park Stroke Service for possible TIA within 72 hours of symptom onset after October 2009 were screened for enrollment in this observational study. 406 patients were invited to enroll, 5 refused. Of the 401 enrolled, follow-up was obtained in 398 patients. Patients were placed into two groups: 1) ABCD 2 scores of 0-3 or 4-5 AND no sign of hemodynamically significant stenosis (<50%) "Low Risk Group"; and 2) those with ABCD 2 scores of 6-7 or 4-5 AND hemodynamically significant stenosis (≥50%) "High Risk Group". Non-invasive arterial imaging included CTA, MRA, and Carotid US - all chosen by the treating physician. 30 day stroke rates with 95% CIs were recorded. Results: Of the 398 patients in whom follow-up data was obtained, 340 (85.4%) fell into the “Low Risk Group”. Within that group, the stroke rate at 30 days was 1.76% (6 strokes, 95% CI 0.72-3.89%). Within the “High Risk Group”, the stroke rate at 30 days was 5.17% (3 strokes, 95% CI 1.21-14.7%). The overall stroke rate was 9/398 (2.26%, 95% CI 1.13-4.31%). Conclusions: In our observational study we continue to find that the overall 30 day stroke rate after TIA was quite low (2.26%). The percentage of all TIA patients falling into the “Low Risk Group” was quite high (85.4%), and these patients had a particularly low rate of stroke at 30 days. Given the high number of “Low Risk” patients and the low rate of stroke in that group at 30 days, the vast majority of TIA patients could likely be safely evaluated in a rapid outpatient setting provided that the treating physician is confident of the diagnosis.

scholarly journals Fetomaternal outcome in women with heart disease in urban population in a tertiary care hospital

2018 ◽  
Vol 7 (9) ◽  
pp. 3684
Author(s):  
Preeti Sharma ◽  
Renuka Malik
Keyword(s):  
Heart Disease ◽  
Maternal Mortality ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Fetal Mortality ◽  
Delivery Mode ◽  
Care Hospital ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Background: Heart disease in pregnancy is still a major problem worldwide, particularly in low resource country like India. Its reported incidence varies between 0.1 to 4%. Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the rheumatic heart disease (RHD) contributes to approximately 70% of heart disease seen in pregnancy. Heart disease in pregnancy is associated with adverse fetomaternal outcome and has re-emerged as one of the leading causes of maternal mortality. The maternal mortality rate in women with cardiac disease is 7% and morbidity is 30% during pregnancy in India.Methods: This study was a prospective observational study conducted in the department of obstetrics and gynaecology at PGIMER & Dr. RML hospital from Nov 2015 to March 2017. 35 Pregnant women with heart disease were taken as study group and 35 low risk pregnant patients were taken as control. Multiple pregnancy and any other medical disorder like GDM, PIH, IHCP and thyroid disorders were excluded from study. Fetomaternal outcome in terms of POG at delivery, mode of delivery, prematurity, LBW, NICU admission and maternal and neonatal mortality were compared between these two groups.Results: Vaginal delivery is still the common mode of delivery. Preterm delivery, prematurity, ICU admission, low birth weight is more common in pregnancy with heart disease than in normal pregnancy.Conclusions: Although maternal mortality and fetal mortality is reduced, pregnancy with heart disease still carries substantial risk to mother and child.

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