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Predictors of spontaneous pregnancy loss in single ventricle physiology.
Wazni, Yasmine; Sefton, Christopher; Sharew, Betemariam; Ghandakly, Elizabeth; Blazevic, Patricia; Mehra, Nandini; Lappen, Justin R; Dolin, Cara D; Kern-Goldberger, Adina; Bacak, Stephen; Fuchs, Margaret; Zahka, Kenneth; McKenney, Amy; Tereshchenko, Larisa G; Singh, Katherine; Aziz, Peter F; Ghobrial, Joanna.
Afiliación
  • Wazni Y; Georgetown University, Washington, District of Columbia, USA.
  • Sefton C; Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
  • Sharew B; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
  • Ghandakly E; Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
  • Blazevic P; University of Toledo College of Medicine, Toledo, Ohio, USA.
  • Mehra N; Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA.
  • Lappen JR; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA.
  • Dolin CD; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA.
  • Kern-Goldberger A; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA.
  • Bacak S; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA.
  • Fuchs M; Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA.
  • Zahka K; Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
  • McKenney A; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Tereshchenko LG; Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA.
  • Singh K; Lerner Research Institute, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
  • Aziz PF; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA.
  • Ghobrial J; Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
Open Heart ; 11(2)2024 Sep 13.
Article en En | MEDLINE | ID: mdl-39277186
ABSTRACT

BACKGROUND:

Pregnant patients with single ventricle (SV) physiology carry a high risk of spontaneous pregnancy loss (SPL), yet the clinical factors contributing to this risk are not well defined.

METHODS:

Single-centre retrospective study of pregnant patients with SV physiology seen in cardio-obstetrics clinic over the past 20 years with chart review of their obstetric history. Patients without a known pregnancy outcome were excluded. Univariable Bayesian panel-data random effects logit was used to model the risk of SPL.

RESULTS:

The study included 20 patients with 44 pregnancies, 20 live births, 21 SPL and 3 elective abortions. All had Fontan palliation except for two with Waterston and Glenn shunts. 10 (50%) had a single right ventricle (RV). 14 (70%) had moderate or severe atrioventricular valve regurgitation (AVVR). Atrial arrhythmias were present in 16 (80%), Fontan-associated liver disease (FALD) in 15 (75%) and FALD stage 4 in 9 (45%). 12 (60%) were on anticoagulation. Average first-trimester oxygen saturation was 93.8% for live births and 90.8% for SPL. The following factors were associated with higher odds of SPL RV morphology (OR 1.72 (95% credible interval (CrI) 1.0008-2.70)), moderate or severe AVVR (OR 1.64 (95% CrI 1.003-2.71)) and reduced first-trimester oxygen saturation (OR 1.83 (95% CrI 1.03-2.71) for each per cent decrease in O2 saturation.

CONCLUSION:

Pregnant patients with SV physiology, particularly those with RV morphology, moderate or severe AVVR, and lower first-trimester oxygen saturations, have a higher risk of SPL. Identifying these clinical risk factors can guide preconception counselling by the cardio-obstetrics team.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Cardiovasculares del Embarazo / Aborto Espontáneo / Ventrículos Cardíacos Límite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Cardiovasculares del Embarazo / Aborto Espontáneo / Ventrículos Cardíacos Límite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido