ABSTRACT
BACKGROUND: Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. AIMS: To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. METHODS: We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. RESULTS: We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. CONCLUSIONS: The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.
Subject(s)
Patient Care Team , Pregnancy Complications, Cardiovascular , Humans , Female , Pregnancy , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/mortality , Pregnancy Complications, Cardiovascular/physiopathology , Adult , Risk Factors , Time Factors , Treatment Outcome , Delivery of Health Care, Integrated , Risk Assessment , Retrospective Studies , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cardiovascular Diseases/mortality , Young AdultABSTRACT
Due to their numerous biological properties, natural sulfated polysaccharides have attracted the interest of the food and pharmaceutical industries. Membrane processes were thought to be especially suitable for their production at industrial scale. The aim of this study was to evaluate the effect of sodium chloride, often used as a preservative and a precipitation adjuvant, on the ultrafiltration of sulfated pentasaccharides. In pure water, results showed a complete retention of the polymers on membranes with molecular weight cut-off up to eight times the molecular weight of the studied pentasaccharides. When NaCl was added to a concentration of 0.5 mol L(-1), retention rates decreased significantly (≈-50%). As no relevant modification of the molecules size was observed through hydrodynamic radius measurements, these variations of selectivity were fully attributed to the screening of membrane surface charges by the electrolyte. Therefore, optimising the ultrafiltration of charged molecules need absolutely exammining electrostatic interactions.
