Easter SR, et al. - Cardiovascular and obstetric morbidity was compared in women with cardiovascular disease according to planned mode of delivery. According to planned mode of delivery, the low and similar rate of cardiovascular morbidity lent supporting evidence to existing guidelines based primarily on expert opinion. With regard to the safety of foregoing an elective cesarean delivery for an attempt at vaginal birth, researchers offered reassurance for pregnant women with cardiovascular disease and their providers.

Methods

• From January 2011 through December 2016, the researchers recruited a prospective cohort of women with cardiovascular disease ≥ 24 weeks gestation delivering at a single tertiary care center.
• They excluded women with a cardiac contraindication to vaginal delivery.
• Women were classified as planned vaginal birth or planned cesarean delivery.
• Then, they compared adverse cardiac outcomes (sustained arrhythmia, heart failure, cardiac arrest, cerebral vascular accident, need for cardiac surgery or intervention, or cardiac death) according to planned mode of delivery using univariate analysis.
• Furthermore, they considered secondary obstetric and neonatal outcomes.
• Because of the small sample size, multiple preplanned sensitivity analyses were conducted to control for differences in baseline comorbidities between the groups.

Results

• The researchers analyzed 272 women after excluding 4 women with cardiac contraindication to vaginal birth.
• Among them, 77% (n=210) attempted vaginal birth and 23% (n=62) planned cesarean delivery.
• Women planning vaginal birth were found to be younger with lower rates of anticoagulation, left ventricular outflow tract obstruction, multiparity, and preterm gestation.
• With a 9.5% operative vaginal delivery rate, 88% (n=181) of planned vaginal deliveries were successful.
• In the cohort, all patients were allowed to Valsalva.
• However, 5 operative vaginal deliveries were performed for maternal cardiac disease at the discretion of the delivering provider.
• Between the groups, adverse cardiac outcomes were similar (4.3% vs 3.2%, p=1).
• In the planned vaginal birth group, rates of postpartum hemorrhage (1.9% vs 11.3%, p<0.01) and transfusion (1.9% vs 9.7%, p=0.01) were lower.
• They found no differences in adverse cardiac, obstetric or neonatal outcomes in the cohort overall or the subset of women with high risk cardiac disease or high obstetric comorbidity indices.