Table 3

Maternal characteristics and obstetric and cardiac outcomes among 2018 ESC-adapted mWHO classes and class X

General characteristics
(n=197 pregnancies)
Class X
(n=38)
Class I
(n=73)
Class II
(n=35)
Class II-III
(n=29)
Class III/IV
(n=22)
P value
BAME ethnicity5 (13.2) a12 (16.4) a3 (8.6) a2 (6.9) a10 (45.5) b0.002
Risk factors for CVD13 (34.2) a26 (35.6) a10 (28.6) a12 (41.4) a17 (77.3) b0.003
First pregnancy15 (39.5)27 (37.0)9 (25.7)8 (27.6)5 (22.7)0.474
Previous caesarean delivery10 (26.3)12 (16.4)7 (20.0)8 (27.6)9 (40.9)0.054
ART conception7 (18.4) a2 (2.7) b1 (2.9) b3 (10.3) a0 b0.010
Multiple gestation7 (18.4) a3 (4.1) b0 b2 (6.9) b0 b0.006
Stillbirth (>22 weeks)02 (2.7)01 (3.4)00.574
Low dose aspirin9 (23.7)17 (23.3)6 (17.1)7 (24.1)6 (27.3)0.912
LMWH8 (21.1)13 (17.8)3 (8.6)8 (27.6)2 (9.1)0.218
PIH11 (28.9)9 (12.3)4 (11.4)3 (10.3)6 (27.3)0.078
HD unknown before pregnancy3 (7.9) a5 (6.8) a7 (20.0) b8 (27.6) b9 (40.9) c0.002
Cardiology assessment38 (100.0)a57 (78.1)b33 (94.3)a29 (100.0)a22 (100.0)a<0.001
In pregnancy26 (68.4)48 (84.2)20 (60.6)24 (82.8)19 (86.4)
Childbirth outcomes
(n=193 pregnancies)
Class X
(n=37)
Class I
(n=70)
Class II
(n=35)
Class II-III
(n=29)
Class III/IV
(n=22)
P value
Induction of labour8 (21.6)17 (24.3)8 (22.9)8 (27.6)4 (18.2)0.949
Epidural analgesia (in labouring women)9/18 (50.0) a20/47 (42.6) a8/22 (36.4) a9/11 (81.8) b9/10 (90.0) b0.009
Preterm delivery <370/7 wks12 (32.4)20/68 (29.4)6 (17.1)6/28 (21.4)7 (31.8)0.527
Vacuum delivery01 (1.4)1 (2.9)02 (9.1)0.067
CD24 (64.9) a25 (35.7) b17 (48.6) a19 (65.5) a13 (59.1) a0.014
Operative delivery for cardiology reasons4/24 (16.7) a8/26 (30.8) b5/18 (27.8) b14/19 (73.7) c10/15 (66.7) c<0.001
PPH ≥1000 mL7 (18.9) a4 (5.7) b0 b2 (6.9) b0 b0.011
Postdelivery ICU admission2 (5.4) a3 (4.3) a2 (5.7) a5 (17.2) a,b9 (40.9) c<0.001
  • Data presented as number (percentage).

  • Cardiology assessment refers to a clinical evaluation by a consultant cardiologist with echocardiography performed when deemed necessary.

  • Cases with miscarriage excluded from analysis of childbirth outcomes.

  • Cases with stillbirth excluded from analysis of preterm delivery <37 weeks’ gestation.

  • Operative delivery includes both vacuum vaginal delivery and caesarean delivery.

  • There was only one patient, in class X, who underwent elective, pre-labour caesarean delivery neither for cardiology nor for obstetric reasons but for neurology indication (previous massive pulmonary embolism complicated by cardiac arrest and hypoxic encephalopathy).

  • Pearson χ2 with Bonferroni’s post hoc analysis to adjust for multiple comparison (shown as a, b, c).

  • ART, assisted reproductive technology; BAME, black, Asian and minor ethnicities; CD, caesarean delivery; CVD, cardiovascular disease; ESC, European Society of Cardiology; HD, heart disease; ICU, intensive care unit; LMWH, low molecular weight heparin; mWHO, modified WHO; PIH, pregnancy induced hypertension; PPH, postpartum haemorrhage.