Abstract:
BACKGROUND:Although consensus guidelines on the management of cardiovascular disease in pregnancy reserve cesarean delivery for obstetric indications, there is a paucity of data to support this approach. OBJECTIVE:The objective of the study was to compare cardiovascular and obstetric morbidity in women with cardiovascular disease according to the plan for vaginal birth or cesarean delivery. STUDY DESIGN:We assembled a prospective cohort of women delivering at an academic tertiary care center with a protocolized multidisciplinary approach to management of cardiovascular disease between September 2011 and December 2016. Our practice is to encourage vaginal birth in women with cardiovascular disease unless there is an obstetric indication for cesarean delivery. We allow women attempting vaginal birth a trial of Valsalva in the second stage with the ability to provide operative vaginal delivery if pushing leads to changes in hemodynamics or symptoms. Women were classified according to planned mode of delivery: either vaginal birth or cesarean delivery. We then used univariate analysis to compare adverse outcomes according to planned mode of delivery. The primary composite cardiac outcome of interest included sustained arrhythmia, heart failure, cardiac arrest, cerebral vascular accident, need for cardiac surgery or intervention, or death. Secondary obstetric and neonatal outcomes were also considered. RESULTS:We included 276 consenting women with congenital heart disease (68.5%), arrhythmias (11.2%), connective tissue disease (9.1%), cardiomyopathy (8.0%), valvular disease (1.4%), or vascular heart disease (1.8%) at or beyond 24 weeks' gestation. Seventy-six percent (n = 210) planned vaginal birth and 24% (n = 66) planned cesarean delivery. Women planning vaginal birth had lower rates of left ventricular outflow tract obstruction, multiparity, and preterm delivery. All women attempting vaginal birth were allowed Valsalva. Among planned vaginal deliveries 86.2% (n = 181) were successful, with a 9.5% operative vaginal delivery rate. Five women underwent operative vaginal delivery for the indication of cardiovascular disease without another obstetric indication at the discretion of the delivering provider. Four of these patients tolerated trials of Valsalva ranging from 15 to 75 minutes prior to delivery. Adverse cardiac outcomes were similar between planned vaginal birth and cesarean delivery groups (4.3% vs 3.0%, P = 1.00). Rates of postpartum hemorrhage (1.9% vs 10.6%, P < .01) and transfusion (1.9% vs 9.1%, P = .01) were lower in the planned vaginal birth group. There were no differences in adverse cardiac, obstetric, or neonatal outcomes in the cohort overall or the subset of women with high-risk cardiovascular disease or a high burden of obstetric comorbidity. CONCLUSION:These findings suggest that cesarean delivery does not reduce adverse cardiovascular outcomes and lend support to a planned vaginal birth for the majority of women with cardiovascular disease including those with high-risk disease.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Easter SR,Rouse CE,Duarte V,Hynes JS,Singh MN,Landzberg MJ,Valente AM,Economy KEdoi
10.1016/j.ajog.2019.07.019subject
Has Abstractpub_date
2020-01-01 00:00:00pages
77.e1-77.e11issue
1eissn
0002-9378issn
1097-6868pii
S0002-9378(19)30903-2journal_volume
222pub_type
杂志文章abstract::Prospective pregnancy evaluation through the combined use of a radioimmunoassay (RIA) for the beta-subunit of human chorionic gonadotropin (beta-hCG) and ultrasound during the first 42 days of gestation after ovulation was performed on a population asymptomatic for first-trimester spontaneous abortion. One hundred for...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90977-8
更新日期:1983-08-15 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine whether a wet mount preparation of endocervical secretions from obstetric patients can accurately rule out the presence of gonococci and Chlamydia trachomatis. STUDY DESIGN:Gravid patients were screened for gonococci and C trachomatis with a deoxyribonucleic acid pr...
journal_title:American journal of obstetrics and gynecology
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更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the relation to infant birth weight of maternal fat and lean tissue during early and late pregnancy. DESIGN:Total and net maternal pregnancy weight, fat, and water were determined from measurements of total body water, body density, and bone mineral mass in 200 women, with the us...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/s0002-9378(99)70181-x
更新日期:1999-01-01 00:00:00
abstract::Sixty-one percent of refractory vulvodynia patients evaluated in a tertiary care vulvovaginal clinic had clinically relevant dermatoses based on dermatopathologist-analyzed vulvar biopsy including: lichen sclerosus, allergic/irritant dermatitis, lichen planus, and other inflammatory or neoplastic dermatoses. Given the...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.03.004
更新日期:2008-11-01 00:00:00
abstract::Candida albicans possesses the ability to switch reversibly and at high frequency between a number of heritable phenotypes distinguishable by colony morphology and in some cases cellular phenotype. In the original switching system identified in C. albicans, it was demonstrated that cells could switch at frequencies as...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90113-5
更新日期:1988-04-01 00:00:00
abstract::The presence of fetal breathing, even if episodic in character, may not indicate fetal well being. In a study of fetal lambs with long-term implantation of catheters and electrodes, five of six lambs which died before the onset of labor had terminal episodes of continuous breathing, preceded by 4 1/4 to 45 1/2 hours o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33138-6
更新日期:1978-08-15 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the association between preeclampsia and cancer incidence. STUDY DESIGN:The Jerusalem Perinatal Study is a population-based cohort of all births to 41,206 residents of Western Jerusalem from 1964-76. Cancer incidence to 2004 was assessed by linkage of the cohort with ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.06.057
更新日期:2009-01-01 00:00:00
abstract::Plasma amino acid analyses on 27 amino acids in serial samples from 15 pregnancies in 14 patients are reported. Variations of amino acid levels with gestational age are reported both for absolute amino acid levels and for levels normalized to total amino acids, with a t test used to determine which amino acids vary si...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(78)90108-4
更新日期:1978-07-01 00:00:00
abstract::Diagnostic procedures in gynecologic urology are no longer limited to the medical history, physical examination, and Marshall test. Newer diagnostic procedures include urethroscopy, urodynamics with cystometry, urethral closure pressure profiles, uroflowmetry, electromyography of the pelvic floor musculature, and radi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)91119-9
更新日期:1980-06-15 00:00:00
abstract:BACKGROUND:Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.06.014
更新日期:2018-11-01 00:00:00
abstract::A 23-year-old, healthy woman underwent hysteroscopy during which Hyskon solution was injected into the uterine cavity. Soon afterward she developed a bleeding coagulopathy followed by acute respiratory insufficiency and pulmonary edema, necessitating endotracheal intubation and artificial ventilation with positive end...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90817-q
更新日期:1990-01-01 00:00:00
abstract::A 44 year old G4P3 presents with massive hernia recurrence and bowel obstruction. Her symptoms resolve with conservative management, and she is delivered by cesarean section at term with herniorrhaphy performed 10 weeks postpartum. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.03.006
更新日期:2014-07-01 00:00:00
abstract::Percutaneous nephrostomy is a useful method of supravesical diversion when ureteral obstruction occurs at initial diagnosis of gynecologic cancer or recurrence of disease. Although survival is prolonged, the attendant quality of life would indicate that percutaneous nephrostomy should be performed only in those cases ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90120-0
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:We characterized US women's preferred and usual sources of reproductive health care. STUDY DESIGN:Data were drawn from the Women's Health Care Experiences and Preferences Study, an Internet survey of 1078 women aged 18-55 years randomly sampled from a national probability panel. We described and compared wom...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.04.025
更新日期:2015-09-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.ajog.2014.04.024
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:Our purpose was to compare patients' satisfaction with the effect of treatment, health-related quality of life, psychologic status, and sexual functioning 2 years after endometrial resection or vaginal hysterectomy for menorrhagia. STUDY DESIGN:Menorrhagic women < or = 50 years old with a mobile uterus small...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(97)70445-9
更新日期:1997-07-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70083-9
更新日期:1999-11-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00469-1
更新日期:2003-08-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.122127
更新日期:2002-04-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1988-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
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更新日期:1978-10-01 00:00:00
abstract:OBJECTIVE:To investigate the prevalence of urogenital symptoms and vaginal atrophy in postmenopausal breast cancer patients on adjuvant endocrine therapy. STUDY DESIGN:A population-based, cross-sectional study on postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched control subjects. Va...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.08.035
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this research was to test a widely publicized theory that nausea and vomiting of pregnancy protects women from ingesting certain vegetables and other foods that produce congenital anomalies and other adverse outcomes of pregnancy. STUDY DESIGN:The theory was tested with use of data on dietary ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
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更新日期:1997-01-01 00:00:00
abstract::The presence and number of mast cells and their relationship to other inflammatory cells were investigated in smears from intrauterine contraceptive devices. The results obtained suggest a possible role of mast cells in the mechanism of action of intrauterine contraceptive devices, on the basis of the peculiar known f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(84)90446-0
更新日期:1984-04-15 00:00:00
abstract:BACKGROUND:Open spina bifida is a major congenital anomaly with an estimated incidence of <1 in 1000. The diagnosis of open spina bifida is usually made during the second trimester, but first-trimester detection rate of spina bifida is increasingly reported. Recently, the mean choroid plexus length to occipitofrontal d...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.08.058
更新日期:2020-08-22 00:00:00
abstract:OBJECTIVE:The recommendation to perform a perimortem cesarean delivery within 4 minutes of maternal cardiac arrest was introduced in 1986. This recommendation was based on the assumptions that cardiopulmonary resuscitation is ineffective in the third trimester because of aortocaval compression, and that fetal and perha...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2005.02.038
更新日期:2005-06-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90288-t
更新日期:1993-11-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to assess the utility of the Advanced Life Support in Obstetrics Course for obstetrics/gynecology first-year residents by triangulating pretest and posttest scores on written test of knowledge by interns, with qualitative surveys by residents, and faculty. STUDY DESIGN:Obstetrics/gy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.10.912
更新日期:2007-05-01 00:00:00
abstract::Fifty-five ewes with chronically catheterized singleton gestations were studied to assess changes in basal concentrations of fetal catecholamines with increasing gestational age. All pregnancies were time dated, and measurements of catecholamines were conducted at least 5 days after placement of fetal catheters when f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90157-1
更新日期:1984-06-15 00:00:00
abstract:OBJECTIVE:We evaluate the interrater reliability of levator hiatus (LH) size and correlate size to other measures of muscle function. STUDY DESIGN:Participants were examined independently by 2 examiners. During maximal contraction of the levator ani, the muscle was assessed by using Brink's scale. The LH was measured ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.08.028
更新日期:2007-02-01 00:00:00