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PART III - PERIPARTUM MATERNAL MYOCARDIAL ISCHEMIA - COMPARATIVE STUDY

Department of Anesthesia, University of Toronto and Department of Community Health Sciences, University of Calgary, Calgary, Alberta

INTRODUCTION

Within the Canadian delivery cohort, women with peripartum maternal myocardial ischemic (PMI) events were compared to women without the events. This allowed examination and comparison of delivery-related events and potential maternal risk factors.

METHODS

This population-based cohort study was approved by the local REB committee. Canadian annual delivery populations were identified within the Canadian Hospital Morbidity Database (CHMD) for each year from 1970 to 1998. Women were separated into two groups, those with and without ICD codes for PMI events during hospitalisation for delivery. The two groups were compared: maternal age at time of delivery, method of delivery, and maternal mortality on hospital discharge. Potential maternal risk factors for PMI events included: gestational diabetes, type I/II DM, PIH, pre-existing hypertension, SLE, renal disease, chronic ischemic heart disease, congenital heart disease, vasculitis, PAN, and hyperlipidemia.

RESULTS

114 women with PMI events were compared to approximately 10 million women who did not have PMI events during hospitalisation in Canada for delivery. The maternal age of women with and without PMI events is displayed in figure 1. Method of delivery was poorly described in hospital discharge data however cesarean delivery was associated with PMI events (37% of women with PMI compared to 16% of women without PMI). Maternal mortality was higher for women with PMI events (1.8%) than women without PMI events (0.015%). Eight of the maternal risk factors were associated with PMI events: gestational diabetes (R.R. = 2.5; 0.9, 6.3), type I / II DM (60; 28, 130), PIH (5.1; 3.2, 8.0), pre-existing hypertension (8.7; 4.3, 17), renal disease (21; 3.0, 148), SLE (50; 7.3, 354), hyperlipidemia (804; 261, 2469), and chronic ischemic heart disease (3718; 1972, 7008)

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In this evaluation, women with PMI events have an increased association with operative delivery methods and death at hospital discharge. Specific maternal co-morbidities exist prior to delivery and appear to increase the risk for a PMI event. Comparison to case reports of PMI events identifies a lower maternal mortality rate in this study.^1,2

REFERENCES

1 Angiology 1996;47: 739.

2 Ann Intern Med 1996;125: 751.[Abstract/Free Full Text]

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