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

<h4>Background/aims</h4>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...

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Autores principales:	Sandra Millington, Suzanne Edwards, Robyn A Clark, Gustaaf A Dekker, Margaret Arstall
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6743e498776d4dcf9ba89221ab723441
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spelling	oai:doaj.org-article:6743e498776d4dcf9ba89221ab7234412021-12-02T20:06:30ZThe association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities.1932-620310.1371/journal.pone.0255070https://doaj.org/article/6743e498776d4dcf9ba89221ab7234412021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255070https://doaj.org/toc/1932-6203<h4>Background/aims</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>ACTRN12617000417381.Sandra MillingtonSuzanne EdwardsRobyn A ClarkGustaaf A DekkerMargaret ArstallPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0255070 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sandra Millington Suzanne Edwards Robyn A Clark Gustaaf A Dekker Margaret Arstall The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities.
description	<h4>Background/aims</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>ACTRN12617000417381.
format	article
author	Sandra Millington Suzanne Edwards Robyn A Clark Gustaaf A Dekker Margaret Arstall
author_facet	Sandra Millington Suzanne Edwards Robyn A Clark Gustaaf A Dekker Margaret Arstall
author_sort	Sandra Millington
title	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_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_sort	association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6743e498776d4dcf9ba89221ab723441
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The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities.

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