Lucy E. Hudsmith

Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012–30/09/2016. Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL). A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1–2 and 3–4, respectively (p = 0.165). Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.

Introduction Children with reconstructed aortas performed for palliation in hypoplastic left heart syndrome (HLHS) have reduced aortic distensibility and unfavourable arterial-ventricular coupling. The impact of these changes on ventricular function and cardiovascular functional performance in surviving adults with single ventricular physiology remains unknown. Methods Cardiac MRI (1.5T) was performed in 10 patients (mean age 19 years ± 2) with HLHS who had undergone aortic reconstruction in childhood, 10 age and gender matched patients with single ventricle physiology but without aortic reconstruction and 10 age and gender matched diabetic controls subjects. Aortic distensibility (defined as (maximum aortic area – minimum aortic area/minimum aortic area)/pulse pressure)) was assessed in the mid ascending aorta throughout the cardiac cycle using steady state free precession imaging and analysed using Matlab software. Congenital patients also underwent routine cardiopulmonary exercise testing (RAMP protocol) to asses parameters of cardiovascular functional performance. Results Patients with HLHS had reduced aortic distensibility compared with patients with single ventricular physiology and diabetics (2.13 10^–3 mmHg ± 1.26 vs. 3.9 10^–3 mmHg ± 1.41 vs. 7.3 10^–3 mmHg ± 1.38, p < 0.01) Figure 1. There were no differences in univentricular volumes or ejection fraction between HLHS and other single ventricular physiology (EF 55% ± 8 vs. 60 ± 5, p = 0.12). All patients with single ventricular physiology had marked cardiac limitation. Functional restriction was more severe in HLHS although did not reach statistical significance; predicted VO₂ max for age and gender 55% ± 18 vs. 60% ± 20 (p = 0.16), reduced cardiac work load 9.27 METS ± 3.6 vs. 10.4 METS ± 3.5 (p = 0.47), VE/VCO₂ slope < 35 n = 6 vs. n = 3 (p = 0.68). Box scatter plot of aortic distensibility in patients with single ventricular physiology compared with matched diabetic subjects Conclusion Adults with reconstructed aortas in hypoplastic left heart syndrome have reduced aortic distensibility and impaired prognostic markers of functional cardiovascular performance before changes in ejection fraction. The potential impact of these findings warrants further study.