Precipitating factors and maternal and neonatal outcomes of heart failure in pregnancy: a retrospective analysis in a la
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MATERNAL-FETAL MEDICINE
Precipitating factors and maternal and neonatal outcomes of heart failure in pregnancy: a retrospective analysis in a large tertiary hospital in China, 2012–2017 Hengxi Chen1,2 · Xiaodong Wang1,2 · Haiyan Yu1,2 Received: 13 April 2019 / Accepted: 15 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To investigate the precipitating factors of heart failure (HF) and to investigate the maternal and neonatal outcomes in pregnant women with HF. Methods We reviewed the medical records of pregnant women with HF who were treated at West China Second University Hospital between September 2012 and September 2017. We recorded baseline characteristics, onset and treatment of HF, comorbidities, modes of delivery, and maternal and fetal mortality and morbidity. Chi-square tests or Fisher’s exact tests were used to explore the comorbidities in different subgroups. Results Seventy pregnant women with HF were identified. The most common pregnancy-specific conditions were severe preeclampsia (36/70, 51.43%) and multiple pregnancies (16/70, 22.86%). The most common nonpregnancy-specific conditions were lung infections (34/70, 48.57%) and cardiac problems (25/70, 35.71%). Sixty patients (85.71%) developed HF during pregnancy. Sixty-seven pregnancies (95.71%) ended in cesarean section. Three maternal deaths (4.29%) from HF were recorded. Of the 87 fetuses, three fetuses (3.45%) ended in miscarriages and stillbirth occurred in 5.75% of fetuses. The mean birth weight of a neonate was 2174.49 ± 609.57 (817–3430) g. There were eight neonatal deaths (8/79, 10.13%). The incidence of lung infection (P = 0.031) or cardiac problems (P = 0.044) differs between patients with NYHA classes II and patients with NYHA classes III/IV. The incidence of lung infection (P = 0.006) was also different in patients with prenatal HF and patients with postpartum HF. Conclusion Peripartum HF is associated with high maternal and neonatal morbidity and mortality. Hypertensive disorders in pregnancy, lung infections, and cardiac problems are most common precipitating factors of HF in pregnancy. Keywords Pregnancy · Heart failure · Comorbidities · Mortality · Morbidity
Introduction
* Haiyan Yu [email protected] Hengxi Chen [email protected] Xiaodong Wang [email protected] 1
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China
2
Pregnancy is characterized by significant increases in both cardiac output and blood volume, which stress on the heart mostly during the 32nd to 34th gestational weeks, at the time of labor, and after delivery [1]. Although these changes are well tolerated in healthy women, women with a known heart problem or with an underlying heart disease may suffer severe adverse consequences such as heart failure (HF
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