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      Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development

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          Abstract

          Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies.

          Methods: Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years).

          Results: MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%).

          Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development.

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          Twins: prevalence, problems, and preterm births.

          Edward Hayes, S. Chauhan, James A. Scardo … (2010)
          The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis-related loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (<48 hours) in twin births. Administration of antenatal corticosteroids is an evidence-based recommendation. Copyright © 2010 Mosby, Inc. All rights reserved.
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            Late results of percutaneous mitral commissurotomy in a series of 1024 patients. Analysis of late clinical deterioration: frequency, anatomic findings, and predictive factors.

            Naim B Farah, E Garbarz, A Vahanian … (1999)
            The optimal use of percutaneous mitral commissurotomy (PMC) in a wide range of patients requires accurate evaluation of late results and identification of their predictors. Late results of PMC were assessed in 1024 patients whose mean age was 49+/-14 years. Echocardiography showed that 141 patients (14%) had pliable valves and mild subvalvular disease, 569 (55%) had extensive subvalvular disease, and 314 (31%) had calcified valves. A single balloon was used in 26 patients, a double balloon in 390, and the Inoue Balloon in 608. Good immediate results were defined as valve area >/=1.5 cm2 without regurgitation >2/4 (Sellers' grade) and were obtained in 912 patients. Median duration of follow-up was 49 months. The 10-year actuarial rate of good functional results (survival with no cardiovascular death and no need for surgery or repeat dilatation and in New York Heart Association [NYHA] class I or II) was 56+/-4% in the entire population. Follow-up echocardiography was available in 90% of the patients who experienced poor functional results after good immediate results and showed restenosis in 97% of these. In multivariate analysis, the predictors of poor functional results were old age (P=0.0008), unfavorable valve anatomy (P=0.003), high NYHA class (P<0.0001), atrial fibrillation (P<0.0001), low valve area after PMC (P=0.001), high gradient after PMC (P<0.0001), and grade 2 mitral regurgitation after PMC (P=0.04). PMC can be performed with good late results in a variety of patient subsets. Prediction of late events is multifactorial. Knowledge of these predictors can improve patient selection and follow-up.
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              Cesarean delivery rates in Saudi Arabia: A ten-year review

              Hassan Ba'aqeel (2009)
              BACKGROUND AND OBJECTIVES: In view of the global increase in the rate of cesarean deliveries (CD), with the associated higher morbidity and mortality, this study was undertaken to review CD rates and some of their determinants over a ten-year period in Saudi Arabia. METHODS: Maternity data for Ministry of Health (MOH) hospitals across 14 administrative regions and other governmental hospitals in nine clusters were collected and the corresponding rates calculated using MOH yearly statistical books from 1997 to 2006. No private hospital data are reported. RESULTS: The overall CD rate significantly increased by 80.2% from 10.6% in 1997 to 19.1% in 2006. The greatest increase of 265% was in the Northern region and the least of 32.8% was in the Royal Commission Hospitals. Both vaginal breech and operative vaginal deliveries showed a significant decrease of 38% and 29%, respectively. There was a significant negative correlation between the increasing CD rate and the decreasing vaginal breech and operative vaginal deliveries rates. The volume of annual deliveries did not influence the CD rate. CONCLUSIONS: A significant increase of more than 80% in the CD rate was observed from 1997 to 2006. A national strategy to reduce the CD rate is needed and will require upgrading of the existing vital registration system. We also recommend that current national data capturing mechanisms be expanded to include private sector data and to include indications for CD.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pak J Med Sci
                Journal ID (iso-abbrev): Pak J Med Sci
                Journal ID (publisher-id): PJMS
                Title: Pakistan Journal of Medical Sciences
                Publisher: Professional Medical Publicaitons (Karachi, Pakistan )
                ISSN (Print): 1682-024X
                ISSN (Electronic): 1681-715X
                Publication date (Print): Jan-Feb 2014
                Volume: 30
                Issue: 1
                Pages: 86-90
                Affiliations
                [1 ]Gulraze A, MRCOG, Perinatology Section, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
                [2 ]Kurdi W, MD, Perinatology Section, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
                [3 ]Niaz FA, MRCP, Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
                [4 ]Fawzy ME, FRCP, Formerly Cardiologist, Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
                Author notes
                Correspondence: Dr. Anjum Gulraze, Dept of Obstetrics & Gynecology, P.O. Box: 3354, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia. E-mail: agulraze@gmail.com
                Article
                DOI: 10.12669/pjms.301.4305
                PMC ID: 3955548
                PubMed ID: 24639837
                SO-VID: b0e5fdb3-c6d8-4aa1-aa0b-dabd4f522940
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 September 2013
                Date revision received : 30 November 2013
                Date revision requested : 1 December 2013
                Date accepted : 2 December 2013
                Categories
                Subject: Original Article

                Keywords: maternal and fetal outcome,childhood development,mitral balloon valvuloplasty,pregnancy
                Data availability:
                Keywords: maternal and fetal outcome, childhood development, mitral balloon valvuloplasty, pregnancy

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