Pregnant Women – ABC CARDIOL

IJCS

Editorial

REBECGA Registry: A Multicenter Study for the Reduction of Maternal Mortality Due to Heart Diseases Manifested During Pregnancy

Karyne Pollo de Souza et al. Christianne Brêtas Vieira Scaramello

According to the literature, although the prevalence of heart disease in pregnancy varies considerably among countries, cardiovascular disease is responsible for 1% to 4% of complicated pregnancies in industrialized countries. This pattern is related to cardiovascular risk factors, such as smoking, diabetes, obesity, and hypertension, especially in low- and middle-income countries, as well as late motherhood and the presence of congenital heart disease, mainly in high-income countries.^,

Improved diagnostic methods and therapeutic alternatives have encouraged maternity by promoting safer pregnancies. However, heart disease is still the leading non-obstetric cause of maternal mortality worldwide. Although the rate of maternal mortality has decreased in Brazil over the last three decades, it continues to be higher than estimated for this millennium.

[…]

Read Full Article

IJCS

Case Report

Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation

Antonio José Lagoeiro Jorge et al. Wolney de Andrade Martins Eliza de Almeida Gripp Breno Macêdo de Almeida … Camila Cezário Rocha Paz Figueroa Cíntia Lobo Sabino

Introduction

Graves’ disease (GD) is an autoimmune disease and the most common cause of thyrotoxicosis,^, with multisystem involvement, that mainly affects women between 40 and 60 years of age. It is the most prevalent cause of autoimmune hyperthyroidism in pregnancy,^, and it can be distinguished from gestational thyrotoxicosis due to the presence of diffuse goiter and previous history of hyperthyroidism. Clinical hyperthyroidism occurs in 0.2% of pregnant women.

Heart failure (HF) is a rare manifestation of decompensated GD and it represents a diagnostic challenge due to low clinical suspicion of this etiology.

[…]

Read Full Article

ABC

Original Article

Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease

Luciana Carvalho Martins et al. Claudia Maria Vilas Freire Carolina Andrade Bragança Capuruçu Maria do Carmo Pereira Nunes Cezar Alencar de Lima Rezende

Abstract

Background:

Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy.

Objective:

To determine the risk factors associated with cardiovascular and neonatal complications.

Methods:

We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories.

Results:

Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity.

Conclusion:

The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).

Read Full Article

ABC

Original Article

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas

Alane Cabral Menezes de Oliveira et al. Arianne Albuquerque Santos Alexandra Rodrigues Bezerra Amanda Maria Rocha de Barros Myrian Cicyanne Machado Tavares

Abstract

Background:

Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations.

Objective:

To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió.

Methods:

Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant.

Results:

We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 – 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 – 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery.

Conclusion:

Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.

Read Full Article

ABC

Original Article

Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort

Fernanda Rebelo et al. Dayana Rodrigues Farias Roberta Hack Mendes Michael Maia Schlüssel Gilberto Kac

Background:

The maternal cardiovascular system undergoes progressive adaptations throughout pregnancy, causing blood pressure fluctuations. However, no consensus has been established on its normal variation in uncomplicated pregnancies.

Objective:

To describe the variation in systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels during pregnancy according to early pregnancy body mass index (BMI).

Methods:

SBP and DBP were measured during the first, second and third trimesters and at 30-45 days postpartum in a prospective cohort of 189 women aged 20-40 years. BMI (kg/m²) was measured up to the 13th gestational week and classified as normal-weight (<25.0) or excessive weight (≥25.0). Longitudinal linear mixed-effects models were used for statistical analysis.

Results:

A decrease in SBP and DBP was observed from the first to the second trimester (β_SBP=-0.394; 95%CI: -0.600- -0.188 and β_DBP=-0.617; 95%CI: -0.780- -0.454), as was an increase in SBP and DBP up to 30-45 postpartum days (β_SBP=0.010; 95%CI: 0.006-0.014 and β_DBP=0.015; 95%CI: 0.012-0.018). Women with excessive weight at early pregnancy showed higher mean SBP in all gestational trimesters, and higher mean DBP in the first and third trimesters. Excessive early pregnancy BMI was positively associated with prospective changes in SBP (β_SBP=7.055; 95%CI: 4.499-9.610) and in DBP (β_DBP=3.201; 95%CI: 1.136-5.266).

Conclusion:

SBP and DBP decreased from the first to the second trimester and then increased up to the postpartum period. Women with excessive early pregnancy BMI had higher SBP and DBP than their normal-weight counterparts throughout pregnancy, but not in the postpartum period.

Read Full Article

ABC

Artigo Original

Maternal-fetal monitoring during dental procedure in patients with heart valve disease

Itamara Lucia Itagiba Neves et al. Walkiria Samuel Avila Ricardo Simões Neves Dante Marcelo Artigas Giorgi … Jorge Francisco Kuhn dos Santos Ricardo Martins Oliveira Filho Cesar José Grupi Max Grinberg José Antonio Franchini Ramires

BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.

Read Full Article