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The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

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...

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Autores principales: Millington, Sandra, Edwards, Suzanne, Clark, Robyn A., Dekker, Gustaaf A., Arstall, Margaret
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301645/
https://www.ncbi.nlm.nih.gov/pubmed/34297761
http://dx.doi.org/10.1371/journal.pone.0255070
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author Millington, Sandra
Edwards, Suzanne
Clark, Robyn A.
Dekker, Gustaaf A.
Arstall, Margaret
author_facet Millington, Sandra
Edwards, Suzanne
Clark, Robyn A.
Dekker, Gustaaf A.
Arstall, Margaret
author_sort Millington, Sandra
collection PubMed
description 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.
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spelling pubmed-83016452021-07-31 The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities Millington, Sandra Edwards, Suzanne Clark, Robyn A. Dekker, Gustaaf A. Arstall, Margaret PLoS One Research Article 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. Public Library of Science 2021-07-23 /pmc/articles/PMC8301645/ /pubmed/34297761 http://dx.doi.org/10.1371/journal.pone.0255070 Text en © 2021 Millington et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Millington, Sandra
Edwards, Suzanne
Clark, Robyn A.
Dekker, Gustaaf A.
Arstall, Margaret
The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title_full The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title_fullStr The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title_full_unstemmed The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title_short The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
title_sort association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301645/
https://www.ncbi.nlm.nih.gov/pubmed/34297761
http://dx.doi.org/10.1371/journal.pone.0255070
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