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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2006.tde-18042007-112300
Document
Author
Full name
Maria Rita de Figueiredo Lemos Bortolotto
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2006
Supervisor
Committee
Zugaib, Marcelo (President)
Andrade, Januario de
Born, Daniel
Kahhale, Soubhi
Nomura, Roseli Mieko Yamamoto
Title in Portuguese
Estudo dos fatores relacionados à determinação da via do parto em gestantes portadoras de cardiopatias
Keywords in Portuguese
Cesárea/efeitos adversos
Cesárea/estatísticas & dados numéricos
Complicações cardiovasculares na gravidez/epidemiologia
Complicações cardiovasculares na gravidez/etiologia
Complicações cardiovasculares na gravidez/mortalidade
Complicações do trabalho de parto
Gravidez de alto risco/efeitos de drogas
Mortalidade materna
Nascimento vaginal após cesárea
Abstract in Portuguese
Os objetivos deste estudo foram: avaliar as freqüências de partos vaginais e cesáreas em mulheres portadoras de cardiopatias, bem como a distribuição dos partos nos diferentes subgrupos de doenças cardíacas: arritmias (A), cardiopatias congênitas (CC) e cardiopatias adquiridas (CA); analisar os fatores clínicos e obstétricos que estiveram relacionados à determinação da via de parto no grupo total de cardiopatas e também nos subgrupos, e avaliar a associação entre o tipo de parto e complicações clínicas e obstétricas. Foram analisados retrospectivamente os dados referentes a 571 gestações de 556 mulheres internadas para parto na Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2001 e 2005. A composição dos grupos foi: A - 57 casos (10%), CC - 163 casos (28,6%) e CA - 351 casos (61,4%). A taxas de cesárea foram 57,2% (total), 45,6% (A), 64,2% (CC) e 55,7% (CA). A indicação da cesárea foi obstétrica em 77% dos casos. Analisando os 425 casos sem cesáreas anteriores, as taxas de cesárea foram: 47,1% (total), 37,8% (A), 57,8% (CC) e 43,3% (CA). A probabilidade de parto cesáreo esteve relacionada à presença de cesárea anterior, idade gestacional no parto inferior a 37 semanas, presença de intercorrências obstétricas, diagnóstico de cardiopatia congênita, insuficiência cardíaca classe funcional (CF) III ou IV, e uso de medicamentos de ação cardiovascular. A paridade maior ou igual a um diminuiu a probabilidade de cesárea. A presença de cesárea anterior foi o principal fator relacionado à probabilidade de parto cesáreo nesta população. Nos subgrupos de cardiopatia (sem cesárea anterior) a probabilidade de cesárea esteve aumentada na presença dos seguintes fatores: A - uso de medicação cardiovascular; CC - CF III/IV e intercorrências obstétricas; CA -intercorrências obstétricas e idade gestacional no parto inferior a 37 semanas. A ocorrência de complicações obstétricas foi 6,8% (total), sendo maior em A (18,6%) e nos partos vaginais (10,7%); complicações clínicas maiores ocorreram em 2,5% dos casos e foram mais freqüentes nos casos de cesárea (3,8%). Conclusão: As taxas de cesárea observadas em gestante com cardiopatia foram elevadas (em especial nos casos de cardiopatia congênita) e correlacionadas à presença de cesárea anterior, insuficiência cardíaca CF III/IV, uso de medicamentos de ação cardiovascular, presença de intercorrências obstétricas e idade gestacional no parto inferior a 37 semanas.
Title in English
Obstetrical and clinical factors related to the mode of delivery in pregnant women with heart disease
Keywords in English
Cesarean section/adverse effects
Cesarean section/statistics & numerical data
Maternal mortality
Obstetric labor complications
Pregnancy complications cardiovascular/epidemiology
Pregnancy complications cardiovascular/ethiology
Pregnancy complications cardiovascular/mortality
Pregnancy high-risk/drug effects
Vaginal birth after cesarean
Abstract in English
This study reviewed the data of 571 pregnancies in 556 pregnant women with heart disease admitted for delivery in a tertiary university hospital between 2001 and 2005. The objectives were to assess the prevalence of cesarean sections and vaginal births among the whole group of cases and in three subgroups: patients with arrhythmias (A - 57 cases / 10%), congenital diseases (CD - 163 cases / 28,6%) and acquired diseases (AD - 351 cases / 61,4%), and to determine the clinical and obstetrical factors related to the mode of delivery in the whole population and in the subgroups, as well as the association between the mode of delivery and clinical and obstetrical complications. The frequencies of cesarean sections were: 57,2% (whole population), 45,6% (A), 64,2% (CD) and 55,7% (AD); the cesarean sections were performed due to obstetrical reasons in 77% of the cases. In the 425 cases with no previous cesarean sections, the frequencies of c-sections deliveries were 47,1% (whole group), 37,8% (A), 57,8% (CD) and 43,3% (AD). The factors related to a higher probability of cesarean section were: previous cesarean section, gestational age at delivery of less than 37 weeks, presence of obstetrical events, diagnosis of congenital heart disease, heart failure (NYHA functional class III/IV) and use of cardiovascular drugs. The parity above 1 was related to a lesser probability of csections, and previous cesarean was the main factor related to the risk of abdominal delivery. In the cases with no previous cesarean sections, according to the subgroups of heart disease, the probability of cesarean section was heightened in the presence of the following factors: group A: use of cardiovascular drugs, CD: functional class III/IV and obstetrical events and AD: obstetrical events and gestational age in delivery less than 37 weeks. The rate of obstetrical complications was 6,8%, most of them in group A and in vaginal birth. Major clinical complications occurred in 2,5% of the cases, and were more related to cesarean sections (3,8%). Conclusion: the rates of cesarean sections observed in pregnant women with heart disease were high (mainly in the CD group), and related to previous cesarean sections, heart failure, use of cardiovascular drugs, presence of obstetrical events and gestational age at delivery less than 37 weeks.
 
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Publishing Date
2007-04-20
 
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