Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study

Figures & data

Table 1. Baseline and obstetrical characteristics, maternal and neonatal outcomes of the study population.

Baseline characteristics
n° 175 patients (181 live birth, 2 stillbirth)
Age	32,6 (±5.6)
BMI	29.8 (±10.2)
Smoke	25/175 (14.3%)
mWHO Classification
I	43/175 (24.6%)
II	31/175 (17.7%)
II-III	48/175 (27.4%)
III	42/175 (24%)
IV	11/175 (6.3%)
Type of cardiopathy
Congenital complex cardiopathy^a	34/175 (19.4%)
Valvular disease	39/175 (22.3%)
Ischemic disease	9/175 (5.1%)
Aortic Disease	28/175 (16%)
Arrythmia	25/175 (14.3%)
Cardiomyopathy	6/175 (3.4%)
Septal Defects	31/175 (17.7%)
NYHA (Beginning of pregnancy)
I	151/175 (86.3%)
II	25/175 (14.3%)
III	0
IV	0
Comorbidities
Hypertension	9/175 (5.1%)
Autoimmune disease	13/175 (7.4%)
Diabetes (pregestational)	6/175 (3.4%)
Thrombophilic disorder	4/175 (2.3%)
Neoplasia	1/175 (0.6%)
Severe asthma/BPCO	4/175 (2.3%)
Obstetric characteristics
Medical Assisted Pregnancy	11/175 (6.3%)
Nulliparity	116/175 (66.3%)
Multiple gestation	7/175 (4%)
Obstetric complications
Hypertensive disorder	12/175 (6.8%)
IUGR	10/175 (5.7%)
Diabetes	16/175 (9.1%)
TPL/PPROM	12/175 (6.8%)
Cholestasis	3/175 (1.7%)
Stillbirth	2/175 (1.1%)
Isoimmunizzation	4/175 (2.3%)
Congenital infections	4/175 (2.3%)
Maternal cardiovascular adverse events (DVT, ischemic events, myocardial infarction, arrythmia, heart failure)	11/175 (6.8%)
Outcomes
Vaginal Delivery	61/175 (34.8%)
Operative Delivery	2/61 (3.27%)
Spontaneous delivery	59/61 (96.7%)
Cesarean section	114/175 (65.2%)
Emergent	27/114 (23.7%)
Planned	87/114 (76.3%)
Gestational age	37.7 (±2.7)
	26–41
Neonatal weight	2856g (±673 g)
SGA	21/175 (12.0%)
Maternal adverse compositum outcome	11/175 (6.3%)
Neonatal adverse compositum outcome	22/181 (12.1%)
Length of hospitalization	3.9 (±2.7)
Readmission rate	6/175 (3.4%)

IUGR: intrauterine growth restriction; TPL: threatened preterm labor; PPROM: premature preterm rupture of membranes; DVT: deep venous thrombosis, SGA small for gestational age.

^aEbstein disease, Fallot disease, Transposition of Great Vessels, Holt Horam Syndrome, Anomalous Venous Return, CAV).

Figure 1 Population study according to the consistency of mode of delivery with ESC Guidelines

Table 2. Primary analysis: univariable comparison between “ESC consistent” and “ESC not consistent.”

n° 175 patients (181 neonates)	ESC consistent (120 pt) [124 neonates]	ESC not consistent (55 pt) [57 neonates]	p-value
Age	32.7 (+5.7)	32 (+5.9)	0.638
BMI	25.4 (5.7)	23.4 (3.9)	0.016
Smoke	16/120 (13.3%)	9/55 (16.3%)	0.297
mWHO Classification
I	38/120 (31.7%)	5/55 (9.1%)	0.004
II	23/120 (19.2%)	8/55 (14.5%)
II–III	31/120 (25.8%)	17/55 (34.5%)
III	23/120 (19.2%)	19/55 (34.5%)
IV	5/120 (4.2%)	6/55 (10.9%)
NYHA ≥2 (beginning of pregnancy) n/tot (%)	13/120 (10.8%)	12/55 (21.8%)	0.064
Comorbidities
Hypertension	8/120 (6.7%)	1/55 (1.8%)	0.057
Autoimmune disease	11/120 (4.2%)	2/55 (3.6%)
Diabetes (pregestational)	4/120 (3.3%)	2/55 (3.6%)
Thrombophilic disorder	1/120 (0.8%)	3/55 (5.5%)
Neoplasia	0/120 (0%)	1/55 (1.8%)
Severe asthma/BPCO	1/120 (0.8%)	3/55 (5.5%)
Obstetric features
Medical Assisted Pregnancy	6/120 (5%)	5/55 (9.1%)	0.484
Nulliparity	68/120 (56.7%)	48/55 (87.3%)	<0.001
Multiple gestations	5/120 (4.16%)	2/55 (3.6%)	0.99
Obstetric complications
Hypertensive disorder	8/120 (6.7%)	4/55 (7.3%)	0.190
IUGR	5/120 (4.2%)	5/55 (9.1%)
Diabetes	11/120 (9.2%)	5/55 (9.1%)
TPL/PPROM	9/120 (7.5%)	3/55 (5.5%)
Cholestasis	3/120 (2.5%)	0/55 (1.7%)
Stillbirth	1/120 (0.8%)	3/55 (5.5%)
Isoimmunization	3/120 (2.5%)	2/55 (3.6%)
Congenital infections	3/120 (0%)	1/58 (0%)
Maternal cardiovascular adverse events (DVT, ischemic events, myocardial infarction, arrhythmia, heart failure)	8/120 (6.7%)	4/55 (7.3%)	1
Outcomes
Vaginal Delivery	61/120 (50.8%)	0/55
Spontaneous Delivery	59/61 (96.7%)
Operative delivery	2/61 (3.3%)
Induction of labor	38/120 (31.7%)	0/55
Cesarean Delivery	59/120 (49.2%)	55/55 (100%)	0.015
Elective CD	46/59 (78%)	48/55 (87.3%)
Emergent CD	13/59 (22%)	7/55 (12.7%)
Gestational Age	38,24 (±2.2)	36,5 (±3.43)	0.0001
	(28–41)	(26–40)
Neonatal weight	2975g (+607 g)	2580g (±768 g)	0.032
SGA	13/120 (10.8%)	9/55 (16.3%)	0.441
Maternal adverse compositum outcome n/tot (%)	8/120 (6.7%)	3/55 (5.4%)	0,796 OR 1.22 (0.34–4.43)
Neonatal adverse composite outcome	9/124 (7.2%)	13/57 (22,8%)	0,002
n/tot (%)			OR 3.74 (CI 95% 1.49–9.74)

BMI: body mass index; IUGR: intrauterine growth restriction; TPL: threatened preterm labor; PPROM premature preterm rupture of membranes; DVT: deep venous thrombosis, SGA: small for gestational age.

Continuous variables expressed as medium value ± SD; discrete variable expressed as n/tot (%).

T-test per continous variables; Chi-Square for discrete variables; Fisher test for values <5.

Table 3. Multivariatble analysis for neonatal composite adverse outcome (CAN).

	Sign.	95% C.I. per EXP(B)
		Inf.	Sup.
GROUP	887	164	4,778
BMI	675	867	1,097
PARITY	,648	389	4,566
mWHO CLASS	695	685	1,765
GESTATIONAL AGE	006	602	,918
MODE OF DELIVERY	743	659	1,793
NEONATAL WEIGHT	338	999	1,000