Introduction
Pregnancy complications and prediction of maternal outcome
Predictors and risk scores
Predictor | Study | Population | Risk points |
---|---|---|---|
CARPREG | |||
Prior cardiac event (heart failure, transient ischaemic attack, stroke, arrhythmia) | CARPREG | CHD, AHD | 1 |
NYHA functional class III/IV or cyanosis (SO2 <90%) | CARPREG | CHD, AHD | 1 |
Left heart obstruction (mitral valve area <2 cm² or aortic valve area <1.5 cm² or peak LVOT gradient >30 mmHg (echocardiography) | CARPREG | CHD, AHD | 1 |
Reduced systemic ventricular systolic function (EF <40%) | CARPREG | CHD, AHD | 1 |
ZAHARA | |||
Prior arrhythmia | ZAHARA | CHD | 1.50 |
NYHA functional class III/IV | ZAHARA | CHD | 0.75 |
Left heart obstruction (peak LVOT gradient >50 mmHg or aortic valve area <1.0 cm² | ZAHARA | CHD | 2.50 |
Mechanical valve prosthesis | ZAHARA | CHD | 4.25 |
Systemic AV valve regurgitation (moderate/severe) | ZAHARA | CHD | 0.75 |
Pulmonary AV valve regurgitation (moderate/severe) | ZAHARA | CHD | 0.75 |
Cardiac medication before pregnancy | ZAHARA | CHD | 1.50 |
Cyanotic heart disease (corrected and uncorrected) | ZAHARA | CHD | 1.00 |
OTHER STUDIES | |||
Prior cardiac event (heart failure, transient ischaemic attack, stroke, arrhythmia) | Tanous | CHD, AHD | |
NYHA functional class III/IV | Song | CHD | |
Kovavisarach | CHD, AHD | ||
Cardiac medication before pregnancy | Tanous | CHD, AHD | |
Anticoagulation therapy | Tanous | CHD, AHD | |
Pulmonary arterial hypertension | Song | CHD | |
Maximum BNP >100 pg/ml | Tanous | CHD, AHD | |
Smoking history | Khairy | CHD | |
Reduced subpulmonary ventricular function and/or severe pulmonary regurgitation | Khairy | CHD | |
Right ventricular dilataton | Song | CHD |
CARPREG N = 599 | Khairy N = 90 | Curtis N = 177 | ZAHARA N = 1302 | Tanous N = 66 | Jastrow N = 312 |
---|---|---|---|---|---|
Risk score–% complications | % complications | ||||
0–5% | 12 | 5 | 6 | 2 | 1.4 |
1–27% | 30 | 18 | 16 | 30 | 19 |
≥1–75% | 100 | 57 | 22 | 50 | – |