Abstract
Background/Aim
To assess the clinical and demographic features of maternal mortality cases among patients with cardiac valvular diseases between 2012 and 2019.
Methods
Maternal mortality due to valvular heart disease between January 2012 and December 2019 in Turkey was retrospectively analyzed. The cases were classified according to New York Heart Association (NYHA) classification based on the severity of the heart disease. NYHA classification groups were divided into two; as class I–II (n = 34) and class III–IV (n = 31). Two groups were compared in terms of demographic and clinical characteristics.
Results
Valvular heart disease was diagnosed in 41 (63.1%) of the cases before pregnancy. It was found that 100% (n = 21) of the warfarin users had switched to low molecular weight heparin treatment due to concerns about warfarin embryopathy after the diagnosis of pregnancy, and only 14.2% (n = 3) of them had been monitorized with Antifactor Xa activity to evaluate the effectiveness of the medication. Two NYHA groups had similar clinical characteristics. Intensive care unit admission rate, frequency of prosthetic valve, rate of thromboprophylaxis, type of valvular disease and reasons of maternal death were similar between the NYHA groups (p < 0.05).
Conclusion
Maternal mortality may be observed in cases with NYHA class I–II in almost similar rates with NYHA class III–IV. Therefore, it is crucial to adequately assess the mortality risk of pregnant women with cardiac valvular pathologies and to achieve early diagnosis and appropriate treatment in order to reduce maternal mortality.
Similar content being viewed by others
Availability of data and material
Yes, it is available.
Code availability
N-A.
References
Beksaç S, Adamova G, Antolic ZN, Crnogorac S, Gliozheni O, Koç A, Mazneikova V, Moisiu R, Motrenko T, Onofriescu M (2008) South East Europe and maternal mortality. Gynecology Obstetrics & Reproductive Medicine 14(3):159–162
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cifkova R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P (2018) 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 39(34):3165–3241
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier L-A, Morton BC, Kells CM, Bergin ML, Kiess MC, Marcotte F (2001) Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104(5):515–521
Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde J-L, Vermeer F, Boersma E (2003) A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24(13):1231–1243
MBRRACE-UK: Saving Lives, Improving Mothers' Care (2020) Lessons to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2016–18. https://www.birthcompanions.org.uk/resources/244-mbrrace-uk-saving-lives-improving-mothers-care-2020. Accessed 19 Oct 2021
Knight M, Tuffnell D (2018) A view from the UK: the UK and Ireland confidential enquiry into maternal deaths and morbidity. Clin Obstet Gynecol 61(2):347–358
Confidential Maternal Death Enquiry in Ireland Report for (2016 – 2018) https://www.ucc.ie/en/media/research/maternaldeathenquiryireland/ConfidentialMaternalDeathEnquiryReport2016%C3%A2%C2%80%C2%932018.pdf. Accessed 19 Oct 2021
Roeder HA, Kuller JA, Barker PC, James AH (2011) Maternal valvular heart disease in pregnancy. Obstet Gynecol Surv 66(9):561–571
Organization WH (2012) The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM. World Health Organization
Ai-ris YC, Molina RL (2019) Maternal mortality in the United States: updates on trends, causes, and solutions. NeoReviews 20(10):e561–e574
Rezk M, Gamal A (2016) Maternal and fetal outcome in women with rheumatic heart disease: a 3-year observational study. Arch Gynecol Obstet 294(2):273–278
Engin-Üstün Y, Çelen Ş, Özcan A, Sanisoğlu S, Karaahmetoğlu S, Gül R, Bilgin S, İrez M, Köse MR (2012) Maternal mortality from cardiac disease in Turkey: a population-based study. J Matern Fetal Neonatal Med 25(11):2451–2453
Roos-Hesselink JW, Ruys TP, Stein JI, Thilen U, Webb GD, Niwa K, Kaemmerer H, Baumgartner H, Budts W, Maggioni AP (2013) Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J 34(9):657–665
Soma-Pillay P, Seabe J, Soma-Pillay P, Seabe J, Sliwa K (2016) The importance of cardiovascular pathology contributing to maternal death: confidential enquiry into maternal deaths in South Africa, 2011–2013. Cardiovasc J Afr 27(2):60
Malik HT, Sepehripour AH, Shipolini AR, McCormack DJ (2012) Is there a suitable method of anticoagulation in pregnant patients with mechanical prosthetic heart valves? Interact Cardiovasc Thorac Surg 15(3):484–488
Chan WS, Anand S, Ginsberg JS (2000) Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med 160(2):191–196
Ginsberg JS, Chan WS, Bates SM, Kaatz S (2003) Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med 163(6):694–698
Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, Rezende SM, Zakai NA, Bauer KA, Dentali F (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2(22):3198–3225
Bennett JA, Riegel B, Bittner V, Nichols J (2002) Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 31(4):262–270
Association NYH (1994) The criteria committee of the New York Heart Association, functional capacity and objective measurement. Little Brown & Company Boston, MA
Anwar AD, Winarno GN, Anggraeni EN (2020) Correlation between risk or severity of heart failure and outcome of pregnancy. International journal of general medicine 13:201
Author information
Authors and Affiliations
Ethics declarations
Ethics approval
The study protocol was approved by the Public Health Agency of the Turkish Ministry of Health.
Consent to participate
Informed consent was obtained from all patients.
Consent for publication
N-A
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yucel, A., Koksal, Z., Ensari, T. et al. Maternal mortality due to valvular heart disease: a population-based study in Turkey. Ir J Med Sci 191, 2531–2537 (2022). https://doi.org/10.1007/s11845-021-02879-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-021-02879-7