PMID- 23575754
OWN - NLM
STAT- MEDLINE
DCOM- 20140219
LR  - 20240318
IS  - 1569-9285 (Electronic)
IS  - 1569-9293 (Print)
IS  - 1569-9285 (Linking)
VI  - 17
IP  - 1
DP  - 2013 Jul
TI  - Is vaginal delivery or caesarean section the safer mode of delivery in patients 
      with adult congenital heart disease?
PG  - 144-50
AB  - A best evidence topic in cardiac surgery was written according to a structured 
      protocol. The question addressed was: is vaginal delivery or caesarean section 
      (CS) the safer mode of delivery in patients with adult congenital heart disease? 
      Of the 119 studies, 13 papers represented the best evidence on the topic. 
      Recommendations are based on 29 262 patients. Those having undergone successful 
      corrective or palliative cardiac surgery for congenital heart disease, in 
      addition to patients with unoperated congenital heart disease are a high-risk 
      obstetric population. Heart disease is a leading cause of maternal mortality in 
      the USA and the UK. Traditionally, CS was regarded as the mode of delivery of 
      choice for high-risk patients, but growing experience in this field has now made 
      this advice appear controversial. Patients are stratified into high- and 
      low-risk, depending on the degree of heart failure symptoms [New York Heart 
      Association (NYHA) class]. All studies demonstrated adverse outcomes in ACHD 
      patients compared with normal age-matched controls. This pertained to a higher 
      overall risk of maternal cardiac death, neonatal death, preterm birth, fetal 
      growth restriction and longer hospital stay. On univariate regression analysis, 
      the variables that imparted the highest risk to mother and foetus, were right 
      ventricular failure, pulmonary regurgitation and pulmonary hypertension (P < 
      0.001). Induction of labour was deemed safe and was not associated with higher CS 
      rates. There was no increase in maternal or neonatal complications in patients 
      who were NYHA class I and II at labour. Patients who were NYHA class III and IV 
      at labour had higher complication rates with adverse feto-maternal outcomes (P < 
      0.0001) and longer intensive care unit and hospital stay (Spearman's correlation 
      0.326, P = 0.007). The largest cohort from the USA (26 973 ACHD births) 
      demonstrated that ventricular septal defect was associated with the highest risk 
      of maternal death and complications (P < 0.05). The data would indicate that 
      patients NYHA class I and II symptoms are suitable for VD. For most NYHA III and 
      IV patients a trail of labour is safe with expedited delivery under good 
      analgesic control as dictated by obstetric needs. Due to high complication risks, 
      CS may be indicated in a proportion of patients.
FAU - Asfour, Victoria
AU  - Asfour V
AD  - Department of Obstetrics and Gynaecology, Epsom and St Helier University 
      Hospitals NHS Trust, Surrey, UK.
FAU - Murphy, Michael O
AU  - Murphy MO
FAU - Attia, Rizwan
AU  - Attia R
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Adult
MH  - Benchmarking
MH  - *Cesarean Section/adverse effects/mortality
MH  - *Delivery, Obstetric/adverse effects/mortality
MH  - Evidence-Based Medicine
MH  - Female
MH  - Heart Defects, Congenital/*complications/diagnosis/mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Infant Mortality
MH  - Infant, Newborn
MH  - Maternal Mortality
MH  - Pregnancy
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
PMC - PMC3686383
EDAT- 2013/04/12 06:00
MHDA- 2014/02/20 06:00
PMCR- 2014/07/01
CRDT- 2013/04/12 06:00
PHST- 2013/04/12 06:00 [entrez]
PHST- 2013/04/12 06:00 [pubmed]
PHST- 2014/02/20 06:00 [medline]
PHST- 2014/07/01 00:00 [pmc-release]
AID - ivt110 [pii]
AID - 10.1093/icvts/ivt110 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2013 Jul;17(1):144-50. doi: 
      10.1093/icvts/ivt110.