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Index of Siu et al for Prediction of Pregnancy Outcome in a Woman with Heart Disease (CARPREG Score)

Purpose: To identify the risk for adverse outcome in a pregnant woman with heart disease using the predictors of Siu et al.

Description

Siu et al identified risk factors for adverse outcomes in pregnant women with heart disease. This can help identify a woman and neonate at risk for complications, which can aid in prevention and early intervention. The authors were investigators for the Cardiac Disease in Pregnancy (CARPREG) study from multiple institutions in Canada.


Study population: 562 consecutive pregnant women with heart disease having 599 pregnancies not ending in miscarriage:

(1) All received comprehensive prenatal care.

(2) 13% of pregnancies had maternal complications (pulmonary edema, cardiac arrhythmia, stroke, cardiac death)

(3) 20% of pregnancies had neonatal complications

 

Outcomes:

(1) cardiac complications in mother

(2) neonatal complications

(3) pregnancy-induced hypertension (PIH)

(4) postpartum hemorrhage

 

Outcome

Risk Factor

Odds Ratio

95% CI

cardiac disease in the mother

history of cardiac event or arrhythmia

6

3 - 14

 

NYHA functional class > II (III or IV) OR cyanosis

6

 2 - 22

 

left heart obstruction

6

3 - 14

 

systemic ventricular dysfunction

11

4 - 34

neonatal complications

NYHA functional class > II (III or IV) OR cyanosis

3

1.1 – 6.1

 

maternal heparin or warfarin during pregnancy

3

1.4 – 8.2

 

maternal smoking

2

1.3 – 3.9

 

multiple gestations

22

6 – 85

 

left heart obstruction

2

1.01 – 2.9

PIH

nulliparity

5

2 – 17

 

systemic lupus erythematosus

24

5 – 108

 

coarctation of the aorta

3

2 – 10

postpartum hemorrhage

peripartum heparin or warfarin therapy of the mother

7

2 – 22

 

cyanosis

27

4 - 177

 

where:

• NYHA = New York Heart Association (see Cardiac chapter)

• prior cardiac events: heart failure, transient ischemic attack, or stroke before pregnancy

• left heart obstruction, one or more of the following: (a) mitral valve area < 2 square cm; (b) aortic valve area < 1.5 square cm; (c) peak left ventricular outflow tract gradient > 30 mm Hg by echocardiography

• systemic ventricular dysfunction: ejection fraction < 40%

 

risk index for cardiac disease in the mother =

= SUM(number of cardiac risk factors present)

 

Interpretation:

• minimum risk index: 0

• maximum risk index: 4

• Of the women who died (3, or 0.53%) all had 1 or more risk factors.

 

Risk Index

Risk of Cardiac Complication

0

5%

1

27%

2 - 4

75%

 


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Specialty

Objective

ICD-10