SPC365

Pregnancy in high cardiovascular risk women: not always a state of grace

Session: Posters (Sessão 1 - Écran 3) - Cardiologia em Populações Especiais 1
Speaker: Ana Lobato de Faria Abrantes

Congress: CPC 2023
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.14 Cardiovascular Disease in Special Populations - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Lobato De Faria Abrantes; Tatiana Guimarães; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Catarina Simões de Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Miguel Azaredo Raposo; Catarina Gregório; João Santos Fonseca; João Mendes Cravo; Diogo Rosa Ferreira; Rui Plácido; Arminda Veiga; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Cardio-obstetrics (CO) has gained an increased relevance over the past years, mirroring the importance of multidisciplinary management of cardiovascular (CV) disease during pregnancy. Maternal cardiovascular risk is stratified according to the modified World Health Organization (mWHO) classification, in women at high or extreme risk (mWHO III-IV) pregnancy should be carefully considered or avoided, respectively.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To describe clinical outcomes of women with high CV risk during pregnancy, followed in an expert center.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Single-center observational study of women followed in a tertiary center by a multidisciplinary team composed of cardiologist, obstetrics, anesthesiology and specialist nurse. Clinical and echocardiographic data were recorded and a descriptive analysis was performed.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> We included 11 pts: 10 with a mWHO III &ndash; 4 pts with mechanical prosthesis (4 mitral and 2 aortic), 5 with dilated cardiomyopathy (DCM) and 1 with history of peripartum cardiomyopathy (PCM) with recovered ejection fraction (EF); and 1 pt with mWHO IV - Ehlers-Danlos syndrome. Mean age was 29&plusmn;6 years, no further CV risk factors were identified, only 1 pt developed gestational diabetes. Most pts (7) were referred to a Cardiology appointment during the second trimester, 2 pts during post-partum period and 1 pt obtained pre-counselling. No maternal death or miscarriage was identified.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding the 4 pts with mechanical prosthesis, 2 pts had to induce labor: one of them didn&#39;t have a CO follow-up (FUP) during pregnancy, and was admitted with severe acute pulmonary oedema associated with progression to respiratory failure resulting in an emergency c-section; the other one wasn&#39;t aware of her pregnancy until the 22</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>th</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> week of gestation, therefore adequate counseling wasn&#39;t provided, warfarin wasn&#39;t interrupted and vaginal labor was induced due to fetal death. The latest was the only pt with post-partum complications due to severe hemolytic anemia and endocarditis. The only pt who fulfill our CO program successfully completed her gestation with no adverse maternal or fetal events reported. 1 pt received pre-counseling and declined pregnancy after considering CV risks.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In pts with DCM, a close FUP was performed (mean 2.8&plusmn;1.2 appointments) and mean EF at baseline was 36&plusmn;1.9%. Only 1 woman developed worsening of EF during pregnancy, with a 14% fall and c-section was performed at 36 weeks due to worsening heart failure with progression to cardiogenic shock during peripartum period. The PCM pt maintained a normal EF with no adverse outcomes recorded.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The pt with extreme CV risk, who chose not to terminate pregnancy despite medical advice, was submitted to an intensive CO FUP with no major CV events.&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In women at high CV risk, pre-pregnancy counseling and close CO monitoring, are essential to ensure adequate management of CV disease and minimize maternal and fetal complications. </span></span></span></p>