E Gelson

Effect of maternal heart disease on fetal growth.

OBJECTIVE: To estimate the effect of maternal heart disease on fetal growth and neonatal outcomes. METHODS: A retrospective cohort study of all women with congenital and acquired heart disease admitted at Chelsea and Westminster Hospital between 1994 and 2010 was performed. The women who delivered immediately before and immediately after each index pregnancy were used as controls. Data were obtained from medical and obstetric notes. Birth weight percentiles were calculated using a customized birth weight percentile program, and neonatal complications (preterm birth, perinatal mortality, and recurrence of congenital heart disease) were noted. RESULTS: Median birth weight percentile was significantly lower in the heart disease group (n=31) compared with the control group (n=49; P<.001 Mann-Whitney U test). The rate of neonatal complications was significantly higher in the heart disease group (34% compared with 15%). Preterm birth occurred in 42 (13%) pregnancies, of which 67% were iatrogenic. Eighty-one (25%) newborns in the heart disease group were small for gestational age, and there were four stillbirths and four neonatal deaths (perinatal mortality rate 20 per 1,000). CONCLUSION: This cohort study suggests a significant reduction in fetal growth rates associated with maternal heart disease, which is also associated with preterm delivery and reduced birth weight. The presence of maternal cyanosis and a reduced cardiac output are the most significant predictors. LEVEL OF EVIDENCE: II

Pulmonary hypertension and pregnancy--a review of 12 pregnancies in nine women.

Please cite this paper as: Curry R, Fletcher C, Gelson E, Gatzoulis M, Woolnough M, Richards N, Swan L, Steer P, Johnson M. Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women. BJOG 2012;119:752–761.

Tetralogy of Fallot: maternal and neonatal outcomes

We performed a retrospective cohort study of 26 pregnancies in 16 women with repaired tetralogy of Fallot (rTOF) delivering at the Chelsea and Westminster Hospital and compared them with 104 controls. The rate of antenatal complications was significantly higher in the rTOF group (30 cf. 13%). Use of epidural anaesthesia was higher (67 cf. 25%) in the rTOF group compared with controls, and the length of the second stage was shorter in both spontaneous and assisted deliveries. However, the mode of delivery and neonatal outcomes were similar in both groups. Mean birthweight centile was lower in the tetralogy of Fallot group, 26 versus 58 in the control group (P = 0.000001, Wilcoxon rank sum test). All women whose babies were <10th centile weight for gestational age had moderate to severe pulmonary regurgitation.

Heart disease – why is maternal mortality increasing?

E Gelson,a MA Gatzoulis,b P Steer,a MR Johnsona a Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK b Adult Congenital Heart Centre, National Heart and Lung Institute and Centre for Pulmonary Hypertension, Imperial College London, Royal Brompton Hospital, London, UK Correspondence: Dr E Gelson, Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. Email egelson@imperial.ac.uk

Marfan syndrome and pregnancy: maternal and neonatal outcomes.

To report outcomes in a recent series of pregnancies in women with Marfan syndrome (MFS).

Pregnancy in women with a systemic right ventricle after surgically and congenitally corrected transposition of the great arteries

OBJECTIVE To determine maternal and neonatal outcomes in women with a systemic right ventricle (RV). STUDY DESIGN A retrospective (historical) cohort study of maternal and neonatal outcomes at a tertiary referral academic obstetric unit (Chelsea and Westminster Hospital, London). RESULTS Nineteen pregnancies in 14 women with a systemic RV were compared with 76 controls. There were no maternal deaths. In the study group cardiac complications occurred in six (32%) pregnancies. Obstetric complications occurred in four (21%) case pregnancies, not significantly higher than in the control group. The rate of neonatal complication was significantly higher in the study population with neonatal complications in 12 (63%) case pregnancies compared with 13 (17%) control pregnancies. The median birthweight centile was 9 in the study population, significantly lower than the control population. CONCLUSIONS Our cohort study demonstrates high maternal and neonatal morbidity and low birthweight in the presence of a systemic RV. Cardiac complications were more common in women with RV dysfunction and arrhythmias prior to pregnancy. Preconception counselling and tertiary care during pregnancy for these patients is highly advisable.

Pregnancy Plus : Valvular heart disease

Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum

Cardiac disease in pregnancy. Part 1: congenital heart disease

• Heart disease is now the most common indirect cause of maternal death in the United Kingdom. • Neonatal morbidity and mortality from fetal growth restriction and prematurity are markedly increased in women with heart disease. • Women with congenital heart disease should ideally have a planned pregnancy managed by a multidisciplinary team which includes obstetricians, cardiologists, anaesthetists, neonatologists and midwives.

Cardiac disease in pregnancy. Part 2: acquired heart disease

• The incidence of both rheumatic and ischaemic heart disease is expected to increase in the UK because of changes in ethnicity and increasing maternal age. • Effective management of valvular heart lesions is based on the treatment of symptoms, with the option of balloon valvuloplasty and valve replacement. • Acute myocardial infarction poses a significant risk of maternal mortality and requires prompt treatment with heparin, beta‐blockers and nitrates. • Peripartum cardiomyopathy, although rare, is associated with significant maternal mortality and morbidity.

Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

Second pregnancies are usually less complicated than first pregnancies, and have a better outcome in terms of fetal growth. We studied a group of women with heart disease to assess whether their second pregnancy was less complicated and resulted in a larger baby.