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Optimal Mode of Delivery Among Pregnant Patients With Cardiomyopathies
Quick Takes
- Among patients with cardiomyopathies, a trial of labor did not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned cesarean delivery.
- Planned cesarean deliveries should be reserved for obstetric or fetal indications, even among patients with cardiomyopathies.
- This study provides data that support our current expert opinion guidelines.
Study Questions:
What is the optimal mode of delivery among patients with cardiomyopathies?
Methods:
This was a retrospective cohort study of patients with cardiomyopathy using the Premier inpatient administrative database. The primary analysis compared outcomes among patients with intended vaginal delivery versus intended cesarean delivery (intention to treat). The secondary analysis compared outcomes among patients with vaginal versus cesarean deliveries (as treated).
Results:
Of 2,291 deliveries, there was no difference in outcomes in patients with intended vaginal versus cesarean delivery: nontransfusion morbidity (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 0.91–1.51), blood transfusion (aOR, 1.27; 95% CI, 0.81–1.98), or readmission (aOR, 1.03; 95% CI, 0.73–1.44). Among patients who actually had cesarean delivery (as treated), there was a twofold higher risk of nontransfusion morbidity (aOR, 2.44; 95% CI, 1.85–3.22) and blood transfusion (aOR, 2.26; 95% CI, 1.34–3.81) versus vaginal delivery.
Conclusions:
The authors conclude that among patients with cardiomyopathies, a trial of labor does not confer higher risk of adverse outcomes compared with planned cesarean delivery.
Perspective:
Planned cesarean deliveries should be reserved for obstetric indications because cesarean deliveries are associated with increased risk of hemorrhage, thrombotic complications, and infection. Very rarely is there a cardiac indication for planned cesarean delivery; these include: 1) patients with premature labor while actively anticoagulated with warfarin, 2) severe symptomatic aortic stenosis, and 3) acute decompensated heart failure unable to be medically stabilized. There has been a lack of data about outcomes among pregnant patients with cardiomyopathies. This observational study showed that a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned caesarean delivery. These findings support the current guideline recommendations to avoid cesarean delivery in the absence of an obstetric or fetal indication.
Clinical Topics: Heart Failure and Cardiomyopathies
Keywords: Cardiomyopathies, Cesarean Section, Pregnancy
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