患有心脏合并症的女性队列中，指南依从性与妊娠期间临床结局的关系。
The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities.
机构信息
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
出版信息
PLoS One. 2021 Jul 23;16(7):e0255070. doi: 10.1371/journal.pone.0255070. eCollection 2021.
BACKGROUND/AIMS: Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications.
METHODS
Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories' clinical outcomes.
RESULTS
This maternal cohort's (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care.
CONCLUSIONS
Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score.
TRIAL REGISTRATION
ACTRN12617000417381.
背景/目的：与患有心脏疾病的孕妇相关的母婴发病率是一个全球性问题，取决于是否提供适当的护理。本研究旨在描述与心脏疾病孕妇围产期指南依从性评分相关的临床变量及其相关性。临床变量包括心脏、围产期和新生儿结局和并发症。
方法
使用回顾性横断面病历审核，提取数据并分类为心脏、产科和新生儿预测因素。线性回归模型用于寻找每个预测因素的依从性评分的平均差异（MD），包括 95%置信区间（CI）和所有三个类别临床结局的显著性值。
结果
该孕妇队列（n=261）的心脏并发症主要是需要治疗的心律失常（29.9%），尤其是 SVT（28%）、新诊断的瓣膜性心脏病和先天性心脏病（24%）和心力衰竭（HF）失代偿（16%）。与没有 HF 的女性相比，患有 HF 的女性的依从性评分更高（MD=3.546，95%CI：1.689，5.403）。选择性 LSCS 分娩方式与更高的依从性评分相关（MD=5.197，95%CI：3.584，6.811），而非选择性 LSCS 亚组。需要入住重症监护/特殊护理病房的婴儿比不需要入住的婴儿有更高的指南依从性评分（MD=3.581，95%CI：1.822，5.340）。
结论
一些与妊娠相关的并发症和发病率与更高的依从性评分相关，这反映了诊断、识别并发症或危险因素、启动适当的多学科参与以及遵循指南是相关的。相反，一些潜在可避免的严重并发症，如败血症，则与较低的依从性评分相关。
试验注册
ACTRN12617000417381。
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