title: Haemorrhagic and thrombotic complications in pregnant women with acquired and congenital cardiac disease.
abstract: BACKGROUND
  Pregnant patients with cardiac disease have significantly higher predicted maternal morbidity and mortality compared to the general obstetric population. Published guidelines on optimal management of these patients recommend multidisciplinary care provision. There are few published data on the incidence of haematological complications in pregnant women with cardiac disease, although the data that does exist suggests a relatively high rate of bleeding and thrombotic events.
  
  
  OBJECTIVE
  To determine the outcomes in terms of haematological morbidity occurring within a cohort of pregnant women with cardiac disease in the setting of multidisciplinary care provision.
  
  
  METHODS
  Patients were identified from a database compiled by the obstetric cardiology service listing all cardiac patients managed in the Rotunda maternity hospital during the period from 2004 to 2011. Data were obtained from the medical and obstetric case notes relating to details of perinatal care and the occurrence of antenatal and postnatal complications.
  
  
  RESULTS
  During the 8-year review period, 451 women with cardiac disease were assessed. Fifty-nine were determined to have moderate to high-risk disease. Each received consultant-delivered multidisciplinary care, where written management strategies were agreed by collaborating senior colleagues either preconceptually or in early pregnancy. No venous thromboembolic events occurred and a modest rate of post-partum haemorrhage (approximately 5%) was recorded. There were no maternal deaths.
  
  
  CONCLUSIONS
  The relatively favourable outcomes observed within our institution highlight the importance of a multidisciplinary approach to the management of pregnant women with cardiac disease, particularly in scenarios where limited published evidence exists to guide management.
authors.forename: Barry
authors.initials: B
authors.lastname: Kevane
authors.forename: Peter
authors.initials: P
authors.lastname: McKenna
authors.forename: Kevin
authors.initials: K
authors.lastname: Walsh
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Donnelly
authors.forename: Karen
authors.initials: K
authors.lastname: Flood
authors.forename: Michelle
authors.initials: M
authors.lastname: Cullen
authors.forename: Mary
authors.initials: M
authors.lastname: Bowen
authors.forename: Patrick
authors.initials: P
authors.lastname: Thornton
authors.forename: John
authors.initials: J
authors.lastname: Loughrey
authors.forename: Sam
authors.initials: S
authors.lastname: Coulter-Smith
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Ní Áinle
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors