ukoss update
TRANSCRIPT
2012;14:148–149DOI: 10.1111/j.1744-4667.2012.00098.x
The Obstetrician & Gynaecologist
http://onlinetog.org
UKOSS update
UKOSS update
Myocardial infarction in pregnancy
� Cardiac disease is a leading cause of maternal deaths inthe developed world and is responsible for one-fifth of allmaternal deaths in the UK.
� The aim of this study was to estimate the incidence ofmyocardial infarction in pregnancy and up to 1 weekpostpartum in the UK and to describe risk factors,management and outcomes.
� Twenty-five cases of myocardial infarction in pregnancywere reported, giving an estimated incidence of 0.7 per100 000 maternities (95% confidence interval [CI] 0.5–1.1), which may represent an underestimate of the trueincidence.
� Many risk factors identified were both recognisable andmodifiable. Maternal age (adjusted odds ratio [aOR] 1.3for every 1-year increase, 95% CI 1.2–1.4, P<0.001),smoking (aOR 3.1, 95% CI 1.3–7.5, P = 0.014),hypertension (aOR 8.1, 95% CI 1.5–42.3, P = 0.018), twinpregnancy (aOR 11.3, 95% CI 2.9–44.6, P = 0.002) andpre-eclampsia (aOR 4.5, 95% CI 1.2–17.2, P = 0.038) wereall independently associated with myocardial infarction inpregnancy.
� Fifteen women (60%) underwent coronary angiography: 9(60%) had coronary atherosclerosis, 3 (21%) had coronaryartery dissection, 1 (7%) had a coronary thrombus,and 2 (13%) had normal coronary arteries. No womendied.
� Management of myocardial infarction in pregnancy washighly variable, indicating a clear need for furtherinformation regarding the safety and outcomes of differentinterventions.
� The addition of pregnancy status as a compulsory field incardiac audit databases would enable routine collection ofthis information.
Reference1 Bush N, Nelson-Piercy C, Spark P, Kurinczuk JJ, Brocklehurst P, Knight
M. Myocardial infarction in pregnancy and postpartum in the UK.Eur J Cardiovasc Prev Rehabil 2011. [Epub ahead of print.]
Risk factors for progression from severematernal morbidity to death� Women continue to die unnecessarily during or after
pregnancy in the developed world.� The aim of this analysis was to compare women with
severe maternal morbidity, identified through UKOSS, withwomen who died from the same conditions, identifiedfrom the UK Confidential Enquiries into Maternal Deathsbetween 2003 and 2008.
� Women were included if they had eclampsia, antenatalpulmonary embolism, amniotic fluid embolism, acute fattyliver of pregnancy or antenatal stroke.
� The women who died were older (age 35+ years,aOR 2.36, 95% CI 1.22–4.56) and more likely to be black(aOR 2.38, 95% CI 1.15–4.92) and unemployed or in routineor manual occupations (aOR 2.19, 95% CI 1.03–4.68). Wealso observed an association with obesity (body mass index≥30 kg/m2, aOR 2.73, 95% CI 1.15–6.46).
� Women from vulnerable populations in the UK thus remainat increased risk of maternal death in the presence of severematernal morbidities.
� It is not clear whether the increased risk of death was relatedto difficulties in access to maternal care through physical(location) or cultural factors.
� There is a place for public health action to reverse the risingtrends in maternal age at childbirth, as well as clinical actionto mitigate its effects, and to reduce the burden of obesity inpregnancy.
� In addition, the development and evaluation of servicesto mitigate the risk of dying associated with being black,unemployed or from routine or manual socioeconomicgroups is essential.
Marian Knight MA DPhil FFPH
Head of UKOSS/Honorary Consultant in Public HealthNational Perinatal Epidemiology Unit,University of Oxford, Old Road Campus,Oxford OX3 7LF, UKEmail: [email protected]
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UKOSS update
Reference1 Kayem G, Kurinczuk J, Lewis G, Golightly S, Brocklehurst P, Knight M.
Risk factors for progression from severe maternal morbidity to death:a national cohort study. PLoS One 2011;6:e29077[http://dx.doi.org/10.1371/journal.pone.0029077].
Acknowledgement
Thank you to all members who contributed information tothese studies.
Further information
Details of these and other UKOSS study results can beobtained from the UKOSS website (www.npeu.ox.ac.uk/ukoss/completed-surveillance). If you would like a reprint ofany UKOSS publication please contact: [email protected]
C© 2012 Royal College of Obstetricians and Gynaecologists 149