Geçirilmiş Kalp Cerrahisi Olan Gebelerde Maternal ve Fetal Sonuçlar: Valvüler cerrahi ve Non-Valvüler Cerrahi Sınıflandırması ile

Öz

Bu retrospektif çalışma, kapak cerrahisi öyküsü olan ve kapak dışı kalp cerrahisi geçiren hamile kadınlarda maternal ve fetal sonuçları sağlıklı kontrollerle karşılaştırmayı amaçlamıştır. Bulgular, daha önce kalp ameliyatı geçirmiş kadınların daha yüksek maternal yoğun bakım ihtiyaçları ve daha düşük doğum ağırlıkları, daha yüksek yoğun bakım ünitesi (YYBÜ) nekabul oranları ve artan fetal kardiyak anomaliler dahil olmak üzere daha kötü neonatal sonuçları olduğunu göstermiştir. Valvüler olmayan grup daha olumsuz neonatal sonuçlar sergilemiştir. Bu sonuçlar, kardiyak cerrahi öyküsü olan kadınlarda gebelikle ilişkili risklerin arttığını vurgulamakta ve sonuçları optimize etmek için multidisipliner takibin öneminin altını çizmektedir.

Anahtar Kelimeler

• kardiyak cerrahi
• gebelik
• yenidoğan sonuçları

Maternal and Fetal Outcomes in Pregnant Women with Prior Cardiac Surgery: A Valve Surgery Classification Versus Non-Valve Surgery Classification

Öz

This retrospective study aimed to compare maternal and fetal outcomes in pregnant women with a history of cardiac surgery—classified into valvular and non-valvular groups—and healthy controls. The findings showed that women with prior cardiac surgery had higher maternal intensive care needs and worse neonatal outcomes, including lower birth weights, higher Neonatal Intensive Care Unıte NICU admission rates, and increased fetal cardiac anomalies. The non-valvular group exhibited more adverse neonatal results. These results highlight the increased risks associated with pregnancy in women with a cardiac surgical history and underscore the importance of multidisciplinary follow-up to optimize outcomes.

Anahtar Kelimeler

• cardiac surgery
• pregnancy
• neonatal outcome

Kaynakça

1. 1. Mahli A, Izdes S, Coskun D. Cardiac operations during pregnancy: review of factors influencing fetal outcome. Ann Thorac Surg. 2000;69(5):1622-6.
2. 2. Green LJ, Kennedy SH, Mackillop L, et al. International gestational age-specific centiles for blood pressure in pregnancy from the INTERGROWTH-21st Project in 8 countries: A longitudinal cohort study. PLoS Med. 2021;18(4):e1003611.
3. 3. Clapp JF, 3rd, Capeless E. Cardiovascular function before, during, and after the first and subsequent pregnancies. Am J Cardiol. 1997;80(11):1469-73.
4. 4. Duvekot JJ, Cheriex EC, Pieters FA, et al. Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments triggered by a primary fall in systemic vascular tone. Am J Obstet Gynecol. 1993;169(6):1382-92.
5. 5. John AS, Connolly HM, Schaff HV, et al. Management of cardiac myxoma during pregnancy: a case series and review of the literature. Int J Cardiol. 2012;155(2):177-80.
6. 6. Siu SC, Sermer M, Harrison DA, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation. 1997;96(9):2789-94.
7. 7. DAVUTOĞLU E, YÜKSEL MA, ÖNCÜL M, et al. Kalp Hastalığı ve Gebelik: Maternal ve Fetal Sonuçlar. Journal Of Clinical Obstetrics & Gynecology. 2015;25(2):103-110.
8. 8. Köşüş A, Köşüş N, Açıkgöz N, et al. Kalp hastalığı olan ve olmayan gebelerde maternal ve fetal sonuçlar açisindan bir fark var mı? Journal of General Medicine/Genel Tıp Dergisi. 2008;18(2).

9. 9. Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J. 2019;40(47):3848-3855.
10. 10. Kanhere AV, Kanhere VM. Pregnancy After Cardiac Surgery. J Obstet Gynaecol India. 2016;66(1):10-5.
11. 11. into Maternal CE. Why Mothers Die (2000-2002). http://www cemach org uk/Publications/CEMACH-Publications/Maternal-and-Perinatal-Health aspx. 2005.
12. 12. Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr. 2016;27(2):111-8.
13. 13. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-97.
14. 14. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21.
15. 15. Khairy P, Ouyang DW, Fernandes SM, et al. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006;113(4):517-24.
16. 16. Srivastava AR, Modi P, Sahi S, et al. Anticoagulation for pregnant patients with mechanical heart valves. Ann Card Anaesth. 2007;10(2):95-107.
17. 17. Born D, Martinez EE, Almeida PA, et al. Pregnancy in patients with prosthetic heart valves: the effects of anticoagulation on mother, fetus, and neonate. Am Heart J. 1992;124(2):413-7.
18. 18. Marcus-Braun N, Segal D, Merkin M, et al. [Anticoagulation in pregnant women with prosthetic heart valve--a new approach for therapy]. Harefuah. 2003;142(7):508-11, 567.
19. 19. Ayad SW, Hassanein MM, Mohamed EA, et al. Maternal and Fetal Outcomes in Pregnant Women with a Prosthetic Mechanical Heart Valve. Clin Med Insights Cardiol. 2016;10:11-7.