Table 1. Classes of recommendation

Table 2. Levels of evidence

Table 3. Estimated fetal and maternal effective doses for various diagnostic and interventional radiology procedures

Table 4. Predictors of maternal cardiovascular events and risk score from the CARPREG study

Table 5. Predictors of maternal cardiovascular events identified in congential heart diseases in the ZAHARA and Khairy study

Table 6. Modified WHO classification of maternal cardiovascular risk: principles

Table 7. Modified WHO classification of maternal cardiovascular risk: application

Table 8. Maternal predictors of neonatal events in women with heart disease

Table 9. General recommendations

Table 10. Recommendations for the management of congenital heart disease

Table 11. Recommendations for the management of aortic disease

Table 12. Recommendations for the management of valvular heart disease

Table 13. Recommendations for the management of coronary artery disease

Table 14. Recommendations for the management of cardiomyopathies and heart failure

Table 15. Recommendations for the management of arrhythmias

Table 16. Recommendations for the management of hypertension

Table 17. Check list for risk factors for venous thrombo-embolism

Table 18. Prevalence of congenital thrombophilia and the associated risk of venous thrombo-embolism during pregnancy

Table 19. Risk groups according to risk factors: definition and preventive measures

Table 20. Recommendations for the prevention and management of venous thrombo-embolism in pregnancy and puerperium

Table 21. Recommendations for drug use

ABPM
: ambulatory blood pressure monitoring
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndrome
AF
: atrial fibrillation
AHA
: American Heart Association
aPTT
: activated partial thromboplastin time
ARB
: angiotensin receptor blocker
AS
: aortic stenosis
ASD
: atrial septal defect
AV
: atrioventricular
AVSD
: atrioventricular septal defect
BMI
: body mass index
BNP
: B-type natriuretic peptide
BP
: blood pressure
CDC
: Centers for Disease Control
CHADS
: congestive heart failure, hypertension, age (>75 years), diabetes, stroke
CI
: confidence interval
CO
: cardiac output
CoA
: coarction of the aorta
CT
: computed tomography
CVD
: cardiovascular disease
DBP
: diastolic blood pressure
DCM
: dilated cardiomyopathy
DVT
: deep venous thrombosis
ECG
: electrocardiogram
EF
: ejection fraction
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESICM
: European Society of Intensive Care Medicine
FDA
: Food and Drug Administration
HCM
: hypertrophic cardiomyopathy
ICD
: implantable cardioverter-defibrillator
INR
: international normalized ratio
i.v.
: intravenous
LMWH
: low molecular weight heparin
LV
: left ventricular
LVEF
: left ventricular ejection fraction
LVOTO
: left ventricular outflow tract obstruction
MRI
: magnetic resonance imaging
MS
: mitral stenosis
NT-proBNP
: N-terminal pro B-type natriuretic peptide
NYHA
: New York Heart Association
OAC
: oral anticoagulant
PAH
: pulmonary arterial hypertension
PAP
: pulmonary artery pressure
PCI
: percutaneous coronary intervention
PPCM
: peripartum cardiomyopathy
PS
: pulmonary valve stenosis
RV
: right ventricular
SBP
: systolic blood pressure
SVT
: supraventricular tachycardia
TGA
: complete transposition of the great arteries
TR
: tricuspid regurgitation
UFH
: unfractionated heparin
VSD
: ventricular septal defect
VT
: ventricular tachycardia
VTE
: venous thrombo-embolism
WHO
: World Health Organization

Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the European Society of Cardiology (ESC) Core Curriculum topics. Guidelines and recommendations should help the …

/pdf/esc-guidelines-on-the-management-of-cardiovascular-diseases-3xh319x7m6.pdf

ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).

https://www.cardioatrio.com/index.php/guias-esc?download=107:manejo-cardiopatas-en-embarazo-ehj-2011-embarazo

ESC Guidelines on the management of cardiovascular diseases during pregnancy The Task Force on the Management of Cardiovascular Diseases

/pdf/2018-esc-guidelines-for-the-management-of-cardiovascular-21pcfph2fl.pdf

2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists

Preeclampsia is a clinical syndrome defined as the new onset of hypertension and proteinuria during the second half of pregnancy1 It afflicts 3% to 5% of pregnancies and is a leading cause of maternal mortality, especially in developing countries2,3 Because the only known remedy is delivery of the placenta, in developed countries preeclampsia is an important cause of premature delivery, usually medically indicated for the benefit of the mother This results in infant morbidity and substantial healthcare expenditure4 Despite the considerable morbidity and mortality, the cause of preeclampsia has remained enigmatic

Both hypertension and proteinuria implicate the endothelium as the target of the disease The hypertension of preeclampsia is characterized by peripheral vasoconstriction and decreased arterial compliance5,6 The proteinuria of preeclampsia is associated with a pathognomonic renal lesion known as glomerular endotheliosis, in which the endothelial cells of the glomerulus swell and endothelial fenestrations are lost7,8 Podocyturia has been recently associated with preeclampsia during clinical disease9; however, whether this is the cause or effect of proteinuria is unknown The glomerular filtration rate is decreased compared with normotensive pregnant women; in rare cases, acute renal failure may develop

Preeclampsia is a systemic vascular disorder that may also affect the liver and the brain in the mothers When the liver is involved, women may present with abdominal pain, nausea, vomiting, and elevated liver enzymes Pathological examination of the liver reveals periportal and sinusoidal fibrin deposition and, in more extreme cases, hemorrhage and necrosis10 The severe preeclampsia variant HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) occurs in ≈20% of women with severe preeclampsia,11 and is named not only for the liver involvement, but also for the disorder of the coagulation system that develops12 Approximately 20% of …

Preeclampsia, a Disease of the Maternal Endothelium The Role of Antiangiogenic Factors and Implications for Later Cardiovascular Disease

A combination of hemolysis, elevated liver enzymes, and low platelets-the HELLP syndrome-is one of the most severe forms of preeclampsia and one for which no definitive treatment is available. The use of corticosteroids has been proposed because of their ability to reduce platelet adhesion, limit platelet removal by the spleen, activate platelets, and exert a direct effect on the endothelium. In this prospective, randomized, double-blind, placebo-controlled trial, 105 women with HELLP syndrome in the postpartum period were assigned to receive either 10 mg of dexamethasone or placebo solution by intravenous injection every 12 hours over 4 days. In addition, all patients received magnesium sulfate to prevent or treat eclamptic convulsions, and captopril to control hypertensive peaks exceeding 180 mm Hg systolic and/or 120 mm Hg diastolic. Baseline characteristics were similar in the 56 women given dexamethasone and the 49 receiving placebo. Complication rates also were similar in the 2 groups. Oliguria was the most frequent complication, followed by hemorrhage at a variety of sites. Acute renal failure occurred in 16% of steroid-treated women and 24.5% of the control group. The respective figures for acute pulmonary edema were 3.6% and 10.2%. No significant differences in either maternal morbidity or mortality were observed. Two steroid-treated patients (3.6%) and 2 placebo recipients (4.1%) died. The groups also were comparable with respect to time in hospital and the need for blood products. There were no significant group differences in the pattern of platelet recovery, levels of aspartate aminotransferase or lactate dehydrogenase, hemoglobin, or diuresis. The investigators conclude that these findings fail to support the routine use of dexamethasone following childbirth in women with HELLP syndrome.

Postpartum Dexamethasone for Women With Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome : A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Bariatric surgery is currently considered as an alternative for the treatment of morbid obesity refractory to conventional clinical treatments. The surgeries more frequently used, which are radical and invasive, yield better and faster results, but are subject to clinical and surgical complications such as intestinal obstructions and subocclusions. Pregnancies in women submitted to this type of surgery are increasingly frequent, and the related complications have been increasingly reported. We present the case of a pregnant woman previously submitted to bariatric surgery who developed subocclusion with intestinal intussusception. This extremely serious complication requires attention for its diagnosis, i.e. , imaging and laboratory exams that are not usually employed during pregnancy. Gestation confuses and impairs their interpretation. In addition to the fact that the only treatment that reaches a good result is invasive, exploratory laparotomy is undesirable during this period. Maternal, fetal and perinatal mortality is usually high. In the present case, delivery occurred spontaneously during the first hours of hospitalization before the surgical procedure. Evolution was good and both mother and newborn, although premature, had good course and were discharged in good conditions.

/pdf/acute-abdomen-in-pregnant-woman-treated-for-bariatric-1uopgv5bq1.pdf

[Acute abdomen in pregnant woman treated for bariatric surgery for obesity: case report]

PURPOSES: To determine the rate of low birth weight and some of the risk factors associated with this event among adolescents. METHODS: A cross-sectional study conducted between October 1994 and December 2009 at a maternity in Campinas, in Brazil, using information generated from the computerized obstetric form. After selection of adolescents who delivered at this hospital, two groups were created, with and without low birth weight, respectively. Relative risk and 95% con!dence interval for all independent variables (risk factors) and the ρ 2 test for some perinatal results were performed. The level of signi!cance was set at 5%. RESULTS: During the study period, 24,000 births occurred at CAISM. Of these, 2,404 occurred among 2,357 teenagers (10.02%) and the frequency of low birth weight was 15.1%. Adolescent pregnancy recurred in 294 (8.2%). Age less than 15 years-old, anemia, smoking, and hypertension were not signi!cantly associated with low birth weight. Antecedent of miscarriage and association with systemic lupus erythematosus increased the risk of low birth weight. Cesarean section and an Apgar score below seven were more prevalent among adolescents with low birth weight, and 85% of all adolescents had less than six prenatal visits. CONCLUSIONS: The prevalence of low birth weight is higher among adolescents than among adult women, and there was a large number of adolescents with less than six prenatal visits . The antecedent of miscarriage and the presence of systemic lupus erythematosus were risk factors associated with the occurrence of low birth weight among adolescents.

Fatores associados ao baixo peso ao nascimento entre adolescentes no Sudeste

The impact of a history of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension

João Luiz Pinto e Silva

Papers

Postpartum Dexamethasone for Women With Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome : A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

[Acute abdomen in pregnant woman treated for bariatric surgery for obesity: case report]

Fatores associados ao baixo peso ao nascimento entre adolescentes no Sudeste

The impact of a history of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension

Lupus eritematoso sistêmico e gravidez