title: Is a planned caesarean section in women with cardiac disease beneficial?
abstract: OBJECTIVE
  In the general population, planned caesarean section is thought to be safer in high-risk situations as it avoids the greater risk of an emergency caesarean section. Only limited data exist on the optimal mode of delivery in women with structural heart disease. We investigated the relationship between mode of delivery and pregnancy outcome in women with pre-existing heart disease.
  
  
  METHODS
  The Registry on Pregnancy and Cardiac Disease is an on-going, global, prospective observational registry of women with structural heart disease. We report on 1262 deliveries, between January 2007 and June 2011.
  
  
  RESULTS
  The caesarean section was planned in 393 women (31%): 172 (44%) for cardiac and 221 (56%) for obstetric reasons of whom 53 delivered by emergency caesarean section. Vaginal delivery was planned in 869 (69%) women, of whom 726 (84%) actually delivered vaginally and 143 (16%) had an emergency caesarean section. Perinatal mortality(1.1 vs 2.7, p=0.14) and low apgar score (11.9 vs 10.1, p=0.45) were not significantly different in women who had a caesarean section or vaginal delivery; gestational age(37 vs 38 weeks p=0.003) and birth weight (3073 vs 2870 g p<0.001) were lower in women delivered by caesarean section compared with women delivered by vaginal delivery. In those delivered by elective or emergency caesarean section, there was no difference in maternal mortality (1.8% vs 1.5%, p=1.0), postpartum heart failure (8.8% vs 8.2% p=0.79) or haemorrhage (6.2% vs 5.1% p=0.61).
  
  
  CONCLUSIONS
  These data suggest that planned caesarean section does not confer any advantage over planned vaginal delivery, in terms of maternal outcome, but is associated with an adverse fetal outcome.
authors.affiliation: Cardiology Department, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Titia P E
authors.initials: TP
authors.lastname: Ruys
authors.affiliation: Cardiology Department, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Integrated Adult Congenital Heart Disease Unit of Vall d' Hebron-Sant Pau University Hospitals. Division of Cardiology. Vall d' Hebron University Hospital. Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Pijuan-Domènech
authors.affiliation: Department of Obstetrics and Neonatology, Sant'Anna Hospital, Torino, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Vasario
authors.affiliation: Hospital Therapy Department, Izhevsk State Medical Academy, Izhevsk, Russian Federation.
authors.forename: Ilshat R
authors.initials: IR
authors.lastname: Gaisin
authors.affiliation: Cardiology Department, Bichat Hospital, Paris, France.
authors.forename: Bernard
authors.identifier: http://orcid.org/0000-0002-9127-348X
authors.initials: B
authors.lastname: Iung
authors.affiliation: Cardiology Department, Norfolk & Norwich University NHS Hospital, Norwich, UK.
authors.forename: Leisa J
authors.initials: LJ
authors.lastname: Freeman
authors.affiliation: Cardiology Department, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Elaine P
authors.initials: EP
authors.lastname: Gordon
authors.affiliation: Cardiology Department, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
authors.affiliation: Cardiology Department, Norfolk & Norwich University NHS Hospital, Norwich, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.affiliation: Cardiology Department, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006331:Heart Diseases; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011446:Prospective Studies; D055815:Young Adult
keywords: CONGENITAL HEART DISEASE; MYOCARDIAL DISEASE; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD); VALVULAR DISEASE