title: Predictors of obstetric complications in women with heart disease.
abstract: OBJECTIVE
  The objective of this study is to evaluate obstetric outcomes in women with heart disease and determine whether current multidisciplinary management approaches adversely affect the mother, the neonate, or both. Also to compare the accuracy of several risk scores (RS) including the modified World Health Organization classification (mWHO) and CARPREG to predict obstetric and neonatal complications and to study the addition value of Uteroplacental-Doppler flow (UDF) parameters to predict obstetric complications.
  
  
  METHODS
  A prospective cohort study examined outcomes in women with heart disease (HD), the majority of whom had corrective surgery and delivered between January 2007 and March 2012.
  
  
  RESULTS
  One hundred and seventy-four patients with 179 pregnancies were included in the study. Obstetric complications, including premature labor, arose in 87 patients (48.6%). Neonatal complications were observed in 11 cases (7%). On multivariate analysis, maternal heart disease was predictive of adverse perinatal events (46 cases, 25.7%) and mode of delivery (Thierry's spatula) of third- or fourth-degree perineal tears (six cases, 3.2%). mWHO classification predicted obstetric complications (p = 0.0001) better than the CARPREG study. Impaired UDF (uterine artery pulsatility index-20 weeks and umbilical artery pulsatility index-32 weeks in HD versus healthy women: 20w 1.12 versus 1.34, p = 0.005; 32w 0.87 versus 1.09, p = 0.008) was associated with adverse obstetric and offspring outcome in the group of HD pregnant women.
  
  
  CONCLUSIONS
  Nearly 50% of pregnancies were associated with an adverse obstetric outcome, particularly IUGR. mWHO was better at predicting obstetric and neonatal complications that CARPREG in all categories. Furthermore, compromised UDF combined with mWHO improved the prediction of obstetric and offspring complications in this population.
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Maria
authors.initials: M
authors.lastname: Goya
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Manel
authors.initials: M
authors.lastname: Casellas
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Carme
authors.initials: C
authors.lastname: Merced
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Antonia
authors.initials: A
authors.lastname: Pijuan-Domenech
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Laura
authors.initials: L
authors.lastname: Galián
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Laura
authors.initials: L
authors.lastname: Dos
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Jaume
authors.initials: J
authors.lastname: Casaldáliga
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Mayte
authors.initials: M
authors.lastname: Subirana
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Valle
authors.initials: V
authors.lastname: Pedrosa
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Mireia
authors.initials: M
authors.lastname: Rojas
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Cristina
authors.initials: C
authors.lastname: Martínez
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Montserrat
authors.initials: M
authors.lastname: Monts
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Andrea
authors.initials: A
authors.lastname: Gascón
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Manel
authors.initials: M
authors.lastname: Mendoza
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Francesc
authors.initials: F
authors.lastname: Baró
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Anna
authors.initials: A
authors.lastname: Suy
authors.affiliation: c Department of Anesthesiology , Hospital Vall D'hebron , Barcelona , Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lopez-Gil
authors.affiliation: c Department of Anesthesiology , Hospital Vall D'hebron , Barcelona , Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Manrique
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.affiliation: b Department of Cardiology , Congenital Heart Disease Unit , and.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Elena
authors.initials: E
authors.lastname: Carreras
authors.affiliation: a Maternal-Fetal Medicine Unit .
authors.forename: Luis
authors.initials: L
authors.lastname: Cabero
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects; D004760:Enterocolitis / Q000453:epidemiology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D014469:Umbilical Arteries / Q000503:physiopathology; D055988:Uterine Artery / Q000503:physiopathology; D014593:Uterine Inertia / Q000453:epidemiology
keywords: Heart diseases; infants; newborns; pregnancy complications; pregnancy outcomes