The management of the second stage of labour in women with cardiac: a mixed methods study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objective
To examine the duration of the passive and active parts of the second stage (SS) of labour in women with cardiac disease (CD) and to assess the adherence to antenatal care plans regarding timing of assisted delivery. Cardiac parameters were measured in a subset of women to investigate any differences between the passive and active SS of labour.
Study design
Cohort study of 73 women with CD, classified into mWHO Class Groups I–IV. Women were matched with an equal number of women controlling for gestational age, maternal age (+/− five years), parity, use of regional anaesthesia, and spontaneous versus assisted delivery. 12 of the 73 women with cardiac disease had cardiac parameters and oxygen saturations measured in the active and passive SS of labours.
Results
Length of passive SS was longer and the active component of the SS was significantly shorter in women with CD, because of a policy of elective assisted delivery. However, thirty four percent pushed for longer than was recommended. No adverse cardiac events were reported. Analysis of Holters showed no evidence of maternal arrhythmia in the active SS. Maternal heart rate increased at a modest but significant rate in the active SS.
Conclusion
Compliance with antenatal recommendations was poor; prolonged pushing was not associated with an increase in cardiac events. A restrictive policy for the duration of the active SS of labour in women with CD is currently based entirely on expert opinion and more prospective studies are needed justify this policy.
To examine the duration of the passive and active parts of the second stage (SS) of labour in women with cardiac disease (CD) and to assess the adherence to antenatal care plans regarding timing of assisted delivery. Cardiac parameters were measured in a subset of women to investigate any differences between the passive and active SS of labour.
Study design
Cohort study of 73 women with CD, classified into mWHO Class Groups I–IV. Women were matched with an equal number of women controlling for gestational age, maternal age (+/− five years), parity, use of regional anaesthesia, and spontaneous versus assisted delivery. 12 of the 73 women with cardiac disease had cardiac parameters and oxygen saturations measured in the active and passive SS of labours.
Results
Length of passive SS was longer and the active component of the SS was significantly shorter in women with CD, because of a policy of elective assisted delivery. However, thirty four percent pushed for longer than was recommended. No adverse cardiac events were reported. Analysis of Holters showed no evidence of maternal arrhythmia in the active SS. Maternal heart rate increased at a modest but significant rate in the active SS.
Conclusion
Compliance with antenatal recommendations was poor; prolonged pushing was not associated with an increase in cardiac events. A restrictive policy for the duration of the active SS of labour in women with CD is currently based entirely on expert opinion and more prospective studies are needed justify this policy.
Date Issued
2016-08-04
Date Acceptance
2016-07-30
Citation
International Journal of Cardiology, 2016, 222, pp.732-736
ISSN
1874-1754
Publisher
Elsevier
Start Page
732
End Page
736
Journal / Book Title
International Journal of Cardiology
Volume
222
Copyright Statement
© 2016 Elsevier Ireland Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000384698300141&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Cardiac disease
Management
Second stage
CONGENITAL HEART-DISEASE
PREGNANT-WOMEN
OUTCOMES
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status
Published