- Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team
Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team
Ukrainian Journal of Perinatology and Pediatrics. 2021.2(86): 17-23; doi 10.15574/PP.2021.86.17
Siromaha S. O.1,3, Davidova Yu. V.1,2, Lymanska A. Yu.2,3, Povoroznik N. V.1, Lazoryshynets V. V.1
1SU «National Institute of Cardiovascular Surgery named after M.M. Amosov NAMS of Ukraine», Kyiv
2SU «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv
3Bogomolets National Medical University, Kyiv, Ukraine
For citation: Siromaha SO, Davidova IuV, Lymanska AYu, Povoroznik NV, Lazoryshynets VV. (2021). Features of diagnosis of pathology of the heart and main vessels in pregnant women. Experience of the national multidisciplinary team. Ukrainian Journal of Perinatology and Pediatrics. 2(86): 17-23. doi 10.15574/PP.2021.86.17
Article received: Mar 03, 2021. Accepted for publication: Jun 18, 2021.
Features of diagnosis of the cardiovascular system in a pregnant or parturient woman affect the correct choice of strategy for their medical care. Examination of a woman with pathology of the heart and great vessels at the gravidity stage requires comprehensive support of the pregnancy heart team with the obligatory involvement of specialists in a particular pathology.
The paper presents the vision of the National Team of Obstetric Cardiology and Cardiac Surgery for diagnostic algorithms for different types of cardiac pathology in pregnant women. The advantages of certain methods of examination of pregnant women with pathology of the heart and main vessels, as well as limitations and precautions performing certain instrumental imaging techniques during pregnancy are discussed.
The specificity of diagnostics during pregnancy, presented in this paper, is based on current recommendations of the European Society of Cardiology, a few studies by individual authors and the own experience of members of a multidisciplinary team operating on the basis of two academic institutions — M.M. Amosov National Institute of Cardiovascular Surgery (ANICVS) and the Institute of Pediatrics, Obstetrics and Gynecology named by O.M. Lukyanova. The paper presents 7.5 years of experience in such cooperation. An expert screening examination of the cardiovascular system was performed on 2818 patients (4448 visits), 162 of whom required specialized examination and treatment at the ANICVS during the period from December 2013 to April 2021.
Due developed and implemented diagnostic program both at the outpatient and inpatient stages of medical care for pregnant and parturient women with severe cardiac pathology, as well as coordinated and professional work of members of the multidisciplinary team, the survival rate in this complex group of patients was 97.3% among pregnant and parturient women and 93.3% among babies.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: pregnancy, cardiac pathology, features of diagnostic algorithm, risk stratification.
REFERENСES
1. ATS. (2002). Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the sixminute walk test. Am J Respir Crit Care Med. 166: 111-117. https://doi.org/10.1164/ajrccm.166.1.at1102; PMid:12091180
2. Bhattacharyya A et al. (2012). Peripartum cardiomyopathy: a review. Texas Heart Institute journal. 39 (1): 8-16.
3. Committee on Obstetric Practice. (2017). Committee Opinion No 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol. 130 (4): e210-e216. https://doi.org/10.1097/AOG.0000000000002355; PMid:28937575
4. Connolly HM, Grogan M, Warnes CA. (1999). Pregnancy among women with congenitally corrected transposition of great arteries. J Am Coll Cardiol. 33: 1692-1695. https://doi.org/10.1016/S0735-1097(99)00046-7
5. Connolly HM, Warnes CA. (1994). Ebstein's anomaly: outcome of pregnancy. J Am Coll Cardiol. 23: 1194-1198. https://doi.org/10.1016/0735-1097(94)90610-6
6. Drenthen W, Pieper PG, Roos-Hesselink JW et al. (2007). Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 49: 2303-2311. https://doi.org/10.1016/j.jacc.2007.03.027; PMid:17572244
7. Fleming SM, O'Gorman T, Finn J, Grimes H, Daly K and Morrison JJ. (2000). Cardiac troponin I in pre-eclampsia and gestational hypertension. BJOG: An International Journal of Obstetrics & Gynaecology. 107: 1417-1420. https://doi.org/10.1111/j.1471-0528.2000.tb11658.x; PMid:11117772
8. Hedengran, Katrine K et al. (2016). Large D-Dimer Fluctuation in Normal Pregnancy: A Longitudinal Cohort Study of 4, 117 Samples from 714 Healthy Danish Women. Obstetrics and gynecology international. 2016: 3561675. https://doi.org/10.1155/2016/3561675; PMid:27190521 PMCid:PMC4852125
9. Kilinc, Gonca et al. (2012). Significance of serum cardiac troponin I levels in pulmonary embolism. Journal of thoracic disease. 4 (6): 588-593. doi: 10.3978/j.issn.2072-1439.2012.10.13.
10. Lazoryshynets VV, Siromakha SO, Davydova YuV ta in. (2018). Sposib monitoruvannia stanu plodu pid chas operatsii na sertsi materi zi shtuchnym krovoobihom. Patent na korysnu model No. 129560 vid 12.11.2018.
11. Leiserowitz GS, Evans AT, Samuels SJ, Omand K, Kost GJ. (1992, Nov). Creatine kinase and its MB isoenzyme in the third trimester and the peripartum period. J Reprod Med. 37 (11): 910-916. PMID: 1460608.
12. Pergialiotis V et al. (2016). Maternal cardiac troponin levels in pre-eclampsia: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine. 29: 20. https://doi.org/10.3109/14767058.2015.1127347; PMid:26745550
13. Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. (1994). Pregnancy in cyanotic congenital heart disease: outcome of mother and fetus. Circulation. 89: 2673-2676. https://doi.org/10.1161/01.CIR.89.6.2673; PMid:8205680
14. Regitz-Zagrosek Vera, Roos-Hesselink JW, Bauersachs J et al. (2018). 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal: 1-83. https://doi.org/10.1093/eurheartj/ehy478; PMid:30219880
15. Siromakha SO, Arvanytakvy SS, Rudenko SA, Lazorishenetc VV. (2019). Coronary insufficiency during pregnancy. Epidemiology, methods of diagnosis and treatment. Ukrainian journal of Perinatology and Pediatrics. 3 (79): 32-39. https://doi.org/10.15574/PP.2019.79.32
16. Siromakha SO, Davydova YuV, Lymanska AIu, Lazoryshynets VV. (2020). Stratyfikatsiia materynskoho y perynatalnoho ryzyku pry patolohii sertsia ta sudyn. Suchasnyi pohliad na problemu. Ukrainskyi zhurnal sertsevo-sudynnoi khirurhii. 3 (40): 98-106. https://doi.org/10.30702/ujcvs/20.4009/049098-106/618.3
17. Siromakha SO, Lazoryshynets VV, Davydova YuV, Lymanska AIu. (2019). Multydystsyplinarnyi suprovid vahitnykh i porodilei iz vrodzhenoiu vadoiu sertsia. Visnyk sertsevo-sudynnoi khirurhii. 1 (34): 31-37. https://doi.org/10.30702/ujcvs/19.35/07(031-037)
18. Siromacha SO, Rusnak AO, Lezhnenko SP, Ogorodnyk AO et al. (2019). Pulmonary embolism in pregnant women and women in childbirth. Ukrainian journal of Perinatology and Pediatrics. 4 (80): 30-38. https://doi.org/10.15574/PP.2019.80.30
19. Siromakha SO. (2020). Orfanni spadkovi zakhvoriuvannia hrudnoi aorty ta vahitnist. Suchasni uiavlennia ta rekomendatsii. Ukrainskyi zhurnal sertsevo-sudynnoi khirurhii. 2 (39): 69-74. https://doi.org/10.30702/ujcvs/20.3905/028069-074
20. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Gordon EP, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Sorensen S. (2001). Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 104: 515-521. https://doi.org/10.1161/hc3001.093437; PMid:11479246
21. Stout K. (2005, Jun). Pregnancy in women with congenital heart disease: the importance of evaluation and counselling. Heart. 91 (6): 713-714. https://doi.org/10.1136/hrt.2004.047886; PMid:15894757 PMCid:PMC1768916
22. Xin Yi Ho, Deepak Mathur. (2017, Jul). Interpretation of Cardiac Enzymes in Hypertensive Disorders of Pregnancy: Seeking Diagnostic Clarity. Journal of Medical Cases. 8 (7): 207-210. https://doi.org/10.14740/jmc2836w
