Pregnancy in women with congenital heart disease
Notice bibliographique
Résumé
With advances in pediatric cardiac surgery, there have been major improvements in the survival of children born with congenital heart disease (CHD).As a consequence, there is a growing population of young women with CHD, the majority of whom will become pregnant.However, for women with CHD, pregnancy imposes a hemodynamic stress on the heart and this can result in pregnancy complications for women and their babies.Although there have been a large number of studies examining adverse pregnancy outcomes in women with CHD, some important questions remain unanswered.For instance, the true maternal mortality risk in women with CHD is not known.This is in part because maternal deaths are rare, few large cohorts are available and because there can be a survivor bias in published series.Rates of maternal cardiac complications, such as arrhythmias or heart failure, are also frequently biased as studies often include women followed in tertiary or quaternary referral centres and not those women followed in smaller hospitals.The impact of CHD on other aspects of care such as length of stay or hospital costs is rarely reported, but is important consideration for women, their families and hospital administrators.The study by Opotowsky et al. 1 examines the epidemiology of cardiovascular events at the time of delivery in women with CHD and addresses many of these unanswered questions.Opotowsky et al. 1 report on maternal morbidity and mortality in a large population of women with CHD.Using the largest all-payer national administrative hospital discharge database in the United States, cardiovascular events during admission for childbirth between 1998 and 2007 were examined.CHD diagnosis was based on International Classification of Diseases 9th Revision (ICD-9) coding and lesion severity was categorized as simple, moderate, complex 2 or unclassified.During the study period, there were 42,602,106 deliveries of which 30,500 were in women with CHD.The annual number of deliveries in women with and without CHD increased by 34.9% and 21.3%, respectively.Maternal mortality at the time of delivery was significantly higher in women with CHD compared to those without CHD [Odd ratio (OR) 6.7, 95% confidence interval (CI) 2.9-15.4].Adverse maternal cardiovascular outcomes were also more common in women with CHD (OR 8.4, 95% CI 7.0-10.0) of which arrhythmias were the most common.Supraventricular arrhythmias were the most common type of arrhythmia accounting for more than 75% of the reported arrhythmias.Women with CHD were also at higher risk for heart failure (OR 8.0, 95% CI 6.7-10.1)and cerebrovascular accidents (OR 41.6, 95% CI 25.8-67.1)at the time of delivery.Women with complex CHD or pulmonary hypertension, regardless of disease complexity, were at highest risk of adverse cardiovascular events during delivery.Caesarean deliveries were more common in women with CHD (32.2% versus 26.5%, p50.0001).Length of stay and hospital costs were longer in women with CHD compared to the general population (3.5 versus 2.6 days, p50.0001 and $11,505 versus $8,006, p50.0001).Deliveries complicated by adverse events in women with CHD were associated with further increases length of stay (5.9 versus 3.4 days, p50.0001) and total charges ($24,888 versus $10,935, p50.0001).This study highlights the growing number of deliveries, the associated risk and the implications for health care for women with CHD.The increasing prevalence of women with CHD admitted for childbirth is consistent with studies recognizing the growing number of adults with CHD in general. 3Similar to other studies of cardiovascular outcomes during pregnancy in women with CHD, arrhythmias and heart
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».