803
PŮVODNÍ497922701004395143193242296315
PRÁCE530922701004489137177218
Adverse274533701004280117152176206242
obstetric300333701003876105133168195220236266
and328533701003472110
neonatal341133701003773112150185211247263
outcomes369033701003876103133171231266296
of400233701003858
pregnancy40763370100376196135173207245276313
in440633701001452
high-risk44743370100375290128153177193222256
women474633701005291151186224
with49863370100526894133
heart513533701003772107131160
disease53113370100385381117152181217
|5584227010018
E7564222701004174
/36738043010732
Vnitř3750804301074592111139166
Lék.3935804301074184122140
2024;70(3):E4-E94095804301074487128168182224265290332353368410452481524567
/47078043010732
VNITŘNÍ48058043010745106127171220280301
LÉKAŘSTVÍ5127804301074084130188235280325377399
www.casopisvnitrnilekarstvi.cz42580430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
a4254963010741
significantly486496301073453103152171196217258300349377397438
higher944496301074968118167212239
prevalence1204496301074977121163205225270319360404
of1628496301074873
newborns1721496301074894159210260288338372
with2113496301076585114164
low2297496301071968134
birth245149630107507097129178
weight26494963010765110129179228256
and,425510301074089138154
conversely,597510301074087136175219246280325344384397
a10115103010741
significantly1070510301073352101149168193213253295343370390430
lower1518510301071967132176203
prevalence1739510301074976119160202222266314355398
of2154510301074872
mature22445103010773114142190217260
newborns.2522510301074792157207257284333366383
These425524301074292138172217
mothers6665243010774123151200246273308
had998524301074890140
a11625243010741
significantly1226524301073453103152171196217258301350377397438
higher1688524301074868118166212239
risk195152430107264680119
of2093524301074873
preterm2190524301075077121150193221296
delivery.2510524301074994114133175219247291303
In2837524301071968
group425538301074976124174224
1,677538301074456
nine761538301074868116162
out951538301074897126
of1105538301074873
191206538301074483
newborns1317538301074894160211261289339373
were17185383010765109137181
premature,1927538301075078122196238266315343387402
of2357538301074873
which24585383010765115134176225
three2711538301072877104148194
were4255523010765109137181
very633552301074185113157
premature818552301074977121195237265314341385
(gestational1231552301072473118153183225253273322371413432
weeks16915523010765110155194232
28-31)1951552301074487116158198216
and2195552301074190140
six236355230107345393
moderately24845523010773123174219246289317360380421
premature425566301075180125201244273323352397
(gestational851566301072475121157188231260281331382425446
weeks13265663010766112159199238
32-36).1593566301074588115158204228243
In1865566301071969
group1964566301075078127178229
2,2223566301074461
there2314566301072878125153198
were25425663010766112140185
two2756566301072999149
moderately4255803010773123173218245287315358378419
premature862580301075078121195237265313340384
births126458030107507097128177211
out1493580301074897126
of1637580301074873
341728580301074489
live-born183558030107193880124154205255282332
fetuses.218558030107246896145179223258275
Not24795803010757106134
a26315803010741
single2690580301073453101151171215
newborn425594301074893159210260288338
in791594301071968
this88759430107287796130
group1045594301074976124173224
was12975943010765107141
very1466594301074185113157
premature.1651594301074977121196237265314342385401
No20805943010758107
neonatal2215594301074894143193235263305325
mortality25685943010774123151183225245264293337
occurred425608301074890130178206234278329
in773608301071968
either86060830107446392142187214
group.1094608301074976124173223239
In1353608301071968
group1441608301074876124173223
2,1684608301074460
the1763608301072877122
frequency190560830107245296147195240289331374
of2299608301074772
abortions2391608301074191141169201221270319353
was27646083010765107141
insignificantly425622301071968101121171220239264285326368417445465506
higher952622301074868118167212239
than1213622301072877118167
in1402622301071967
group1491622301074976124173224
117366223010744
(5.6%180162230107246783128195
vs2018622301074075
0%21146223010744113
of2248622301074873
fetuses).234362230107236796145179224259281295
We5656363010775117
found709636301072372121169219
no955636301074998
significant1080636301073452102151170194214255297346373
differences148063630107496892120164191235284325368402
between1909636301075095124192236282330
groups2266636301075076124173223257
regarding2550636301072770121162189238257305355
maternal4256503010774115143186213262303323
outcomes774650301074897126165212287331366
except1166650301074484124167217245
for143865030107247299
increased1564650301071967108135178219252297348
prevalence1938650301075078121162204223268317358401
of2365650301074873
heart2464650301074994134161192
failure268365030107246685104152179222
in425664301071967
group519664301074976124172222
17686643010744
(Table839664301072470105155175219
5).108566430107446781
Among11936643010753127176225275
all149566430107416079
pregnant1601664301075077120171219261309336
women,19646643010765114188233282298
one2288664301074898142
patient2457664301075092119139183231259
died2742664301075069113163
(mWHO425678301072495167224285
IV),73567830107196693107
which8676783010765113132172220
corresponded1112678301074087114141184218267316365414458508
to1645678301072875
maternal17456783010773114141184210259300319
mortality20896783010773122149180221240259287329
of2443678301074872
1.9%254067830107445597165
of2730678301074872
all282767830107416078
pregnancies.425692301074975117165212251298337355398430446
This887692301074189107139
was10416923010764104136
a11936923010740
31-year-old1248692301074381103142184223248272321340388
primigravida165169230107497593165183230256296335353401441
with2107692301076482109156
severe2279692301073376115157183224
pulmonary2519692301074895114185232279319344386
arterial42570630107416798141167186227246
hypertension693706301074987138183209240283331364382430479
(PAH),1194706301072469116173196210
which14277063010765113132172220
was16707063010765106139
diagnosed1832706301074968108157205254287332382
in2236706301071967
the2326706301072776120
35th2469706301074385255270680631645
week26207063010765108153191
of2834706301074872
pregnancy.425720301075078121172220262310351394407
None8587203010758108157202
of1086720301074973
the1186720301072877122
pregnant1334720301075178121172221262311338
women16997203010765114189234282
had2008720301074990140
a21757203010741
thrombotic2243720301072877104151226276326354373414
event,2684720301074485129178205221
aortic425734301074189116147166206
dissection649734301074968101134178220250269317365
during1033734301074996122142190239
pregnancy1290734301075077120170218259307347390
or1698734301074875
up1791734301074897
to1906734301072875
discharge,1999734301074968101141189230256304348363
or2380734301074875
postpartum2473734301075099133162212253280311359432
haemorrhage.425748301074889133207255282309358399448492507
Odds5657623010760111160193
ratios78276230107266895114162196
(OR)1001762301072483129152
of1177762301074872
selected127376230107347897141182213255305
obstetric1602762301074898132161203231258277317
and1943762301074189139
neonatal2105762301074993142191231258300319
outcomes2448762301074796124162209283327361
of2833762301074872
pregnancies425776301075077120170218258306347366409443
are888776301074167110
given1018776301074967108152200
in1237776301071967
Figure1324776301074160109156183226
1.1569776301074455
Discussion30473674013872105157207271323375408470534
Obstetric31873843010760111145174216244271290331
and3544384301074189139
offspring370938430107487299134184211230278328
risks406338430107264679116153
are4242384301074167111
increased4379384301071967107134177217251295345
in4750384301071967
women48433843010766113188232280
with5150384301076584112160
heart5337384301074892133159190
disease.3047398301074968100145185218262277
The3345398301074292136
magnitude35023983010774115164212231259307356400
of3923398301074872
them4017398301072776120193
is4232398301071851
related430439830107277089130157199249
to4575398301072874
maternal46703983010774115142185211260301320
cardiac5011398301074081108156175215255
risk528839830107264678116
(2).542539830107246789102
In3047412301071967
the3131412301072876121
current3269412301074088114141184232259
study3545412301073463111160201
group,3763412301074975122171220234
we40154123010765108
found4140412301072472120168217
significantly4375412301073351100148167191211251292341367386426
worse48194123010765112139174218
obstetric5054412301074898132161203231258277317
and5389412301074088138
neonatal3047426301074892141190231258299318
outcomes3391426301074896124163209283328361
in3778426301071866
mWHO38704263010774145203264
III-IV41594263010719385785105152
classes4336426301074159100133167211245
compared4606426301074087161210252278321371
to5003426301072874
mWHO51034263010773145203264
<53924263010754
III547142630107193857
classes.304744030107405999132165209243259
The3323440301074191135
most34744403010774122155184
robust3675440301072673123171204232
data3924440301074989116157
on4098440301074896
pregnancy4210440301075077119169217258305346388
outcomes4614440301074896124162209282326360
in4990440301071967
women50734403010765113186230278
with5368440301076484111159
heart3047454301074892133159190
diseases3255454301074968101145185218262296
is3570454301071851
provided3639454301075077124164184233277327
by3985454301074989
the4092454301072876120
ROPAC42314543010745106152199248
registry4497454301072770120139171200227270
(3).478645430107236687100
In4905454301071967
the4990454301072876120
years5129454301073983123149183
20072018,53314543010744871321743047468301074385124162177
57393240468301074384126167
pregnancies3423468301074975117166213252299339357399432
were38714683010764106132174
prospectively4060468301074975121154202246286315334374416434473
included4549468301071865105123169217260309
in4874468301071865
1384955468301074380122
centers5093468301073980128154195221254
in5363468301071865
535444468301074383
countries.3047482301074087135183210237256300333350
Congenital3415482301075198147196240288307335376395
heart3828482301074993133159190
diseases4036482301074968101145185218262296
(57%)4350482301072466108174196
and4564482301074189138
valvular4720482301074182101142191210250277
diseases5015482301074967100144185218262296
(29%)5329482301072466109177198
dominated.3047496301074895168185232272298339388403
Maternal34664963010769109135176202249289307
mortality37884963010773120146176216235252279321
was41244963010764104137
0.6%,4276496301074358101165181
while44734963010764111129147190
the4678496301072774117
highest4811496301074765113160203235263
was50904963010764104136
in5242496301071865
PAH5322496301074591146
–54834963010744
9%30475103010744112
(3).318651030107246688101
This3314510301074292111144
corresponds3484510301074087115142185219269318367417450
to3961510301072875
our4062510301074997124
experience4212510301074484135180207226270319360402
when46415103010765114159207
the4875510301072876121
only5022510301074998117157
maternal52065103010774115142185212261302321
death3047524301074993133160208
was32755243010765107140
in3435524301071866
a35215243010741
pregnant3582524301074976119169217258306333
woman39355243010765112186227275
with4230524301076584112160
PAH4410524301074592149
(maternal4579524301072395135163205232280321340
mortality49395243010773122149180221240259287329
1,9%).528852430107445496164185198
Obstetric31875379011063117155188234267299322363
complications3570537901104090167220244268309355387410461514551
were41415383010765108135178
very4339538301074184111154
common4513538301074087161235283332
in4865538301071967
the4952538301072876120
ROPAC50935383010745106152199248
registry5362538301072669119138304755230107346389132
–32045523010745
17%3274552301074481146
(3).344555230107246688101
It3571552301071946
also364255230107416092141
corresponds3808552301074086113140183217266315364414446
to4279552301072875
our4378552301074897123
results,4526552301072669103150169197232247
especially4798552301074478127172213232272291309349
in5172552301071967
mWHO52645523010773145203263
classes3047566301074059100133166210244
III-IV.33105663010719385785105152163
All349256630107527190
our3601566301074896122
patients3742566301075092119137181229256291
in4052566301071967
these4138566301072776120154198
classes435556630107405999132166210244
had4618566301074889138
an4775566301074189
operative4883566301074898143169211238257298341
delivery5243566301074993112130172215241284
and,3047580301074189138154
compared3223580301074087161211252279322372
to3617580301072875
lower-risk3714580301071967132176202227254273306344
patients4080580301075092119137181229256291
in4394580301071866
mWHO44835803010774145203264
classes4769580301074059100133166210244
<50365803010753
III,51125803010719385672
they5206580301072876121160
had5389580301074889138
a30475943010741
significantly3114594301073453102150169193213253295343370390430
shorter3570594301073482131158189232258
duration3855594301074997123165192211260309
of4190594301074872
pregnancy,4289594301075077120170218259308348391403
longer4718594301071968117166211237
hospitalization,4982594301074897130180199227269288307344386413432481529545
and3047608301074189138
greater3205608301074975118158186228255
blood3479608301075070118167217
loss.3716608301071967100134150
Special3187622301074291136177196236255
attention346262230107406898141189216234282331
should3813622301073381130178197246
be4079622301074994
paid4193622301075091110159
to4372622301072774
the4466622301072876120
termination460662230107287097171190237278305324372421
of5046622301074872
pregnancy5138622301075077120170218258306347389
per3047636301075095121
C.s.3185636301075167101118
According3320636301075392131177204252271319368
to3705636301072874
the3796636301072876120
ESC,3933636301074284136152
the4101636301072876120
indications4238636301071967116135175216243262310359392
are4646636301074168111
limited4773636301071938111130158200250
–50406363010745
dilatation510263630107486786126153195222241288337
of5456636301074872
the3047650301072875119
ascending3182650301074173113155203252270317366
aorta3564650301074188115145186
>37666503010753
453836650301074384
mm,39356503010773146161
severe4112650301073477117160186229
aortic4357650301074088114145163203
stenosis,4576650301073462104152199233250283298
severe4890650301073477117160186228
pulmonary5135650301074997115188235283324350392
hypertension3047664301074887137182209240282330363382430478
(including354466430107244290131150197246265313362
Eisenmenger392566430107426193137186259303351401445471
syndrome),4415664301073475124173200247321365387400
severe4834664301073478119162188231
heart5084664301074893133159190
failure,529366430107246684103150177220234
and3047678301074087135
prenatal3198678301074975117163203229270288
treatment350167830107285395134161233276323349
with3865678301076483110157
oral4037678301074874114132
anticoagulants4185678301074087113131170215256304350369408455481515
(recommendation471567830107244789129174247319362409457496523541588635
class536567830107405898130162
IIa,30476923010719377792
level3155692301071962102144163
of3334692301074770
evidence3420692301074383102150193241280322
C)3758692301075175
(1).38496923010724638092
In3957692301071966
the4039692301072775118
ROPAC41736923010745104149195244
registry,4433692301072668117135167195222264275
the4724692301072775118
pregnancy4858692301074975117166213253300340382
was52556923010765105138
terminated5409692301072769953047706301077492140181208250300
per3364706301074994121
C.s.3501706301075268102119
in3636706301071967
44%3720706301074490155
of3892706301074872
pregnancies3980706301075077120170218258306347365409442
(3).443970630107246687101
In4556706301071967
our4640706301074896122
cohort,4779706301074086135183210241257
deliveries5053706301074993112130171215241260304337
per5407706301075095121
C.s.3047720301075168102119
were31857203010765108135177
more33817203010774123150193
often3593720301074771103145194
and3806720301074189138
over-indicated,3963720301074888131158182202250299318358400427469520535
compared4517720301074087161210252278321371
to4907720301072875
ESC5001720301074284136
guidelines5156720301074996115164208227246294338372
and3047734301074189138
the3201734301072876120
ROPAC33387343010745106151198247
registry.3602734301072669119138170199226268280
The3899734301074291135
prevalence4051734301074976119159201220263311352394
of4462734301074771
deliveries4550734301074993112130171214240259303337
per4903734301075094121
C.s.5040734301075268102119
was51757343010765106139
100%5331734301074483129196
in3047748301071967
mWHO31317483010774146203264
classes341374830107405999132166210244
III-IV,36747483010719385785106152162
64%3854748301074490155
in4027748301071866
mWHO41117483010773145203264
classes4392748301074059100133166210244
<46547483010753
III,47257483010719385672
and4815748301074089138
77%4970748301074488154
in5141748301071967
our5226748301074896122
total5366748301072774101143162
cohort.3047762301074087135184211242258
Indication3325762301071967116135175217244262311359
criteria370476230107406686114156183202242
for396676230107247198
the4084762301072776120
delivery4224762301074893112130171214241284
per4528762301074994121
C.s.4668762301075268102119
were48077623010765108134177
met50047623010774118146
according5169762301074182121167194242261309358
to3047776301072874
the3138776301072876121
ESC3275776301074285136
guidelines3428776301074997115164209228246294338372
in3817776301071966
the3900776301072876121
given4037776301074968109152200
groups4254776301074976123171220254
only4525776301074896115155
in4697776301071967
79%,4781776301074486153170
0%49687763010743111
(!),50967763010724426679
or5192776301074875
29%5284776301074487154
of5455776301074872
Tab.42556701135093144171
3.62356701135479
Obstetric729576010758104134161197224249267305
outcomes105057601074591117152195267305337
of140357601074568
pregnancies148757601074571108153199244291328346384415
Group27127130985383129175223
1295271309842
(n27268130982468
=281181309848
19)28758130984383106
Group37827130985383129175223
2402271309842
(n37788130982468
=386381309848
33*)39278130984385120143
p497076309847
Length4569330983982128175204251
of7239330984572
hospitalization8119330984692126173195224265287308344387415436482529
(days;13569330982569111150184203
median157693309867110158179220267
±185993309848
IQR)19239330982279126150
13.02685936095397387126
±282993609548
14.02894936095397488128
5.03790936095395292
±390093609547
2.33965936095395393
<487693609548
0.0014941936095395393134170
Birth4561053098466897127174
per64610530984790119
Caesarean78210530984788130165207236278319366
section116410530983476113144165211257
19270210560953973
(100%)27931056095215792133193213
21376310560953975
(63.6%)38551056095215997111151210229
<4897105609548
0.0149621056095395393129
Completed45611730984792161208230272301343391
week863117309860102144186
of106611730984571
pregnancy115411730984776118165212253300336379
35.727041176095397690128
±2850117609547
3.129151176095395388
38.537711176095397893133
±3921117609548
1.339871176095394989
<4856117609548
0.000149211176095395393134175211
Estimated45612930984176105126194236264306354
blood82612930984769115161209
loss105112930982167101135
(ml)120212930982491112137
572269912960953977116
±2832129609548
156289712960953973112
474377712960953975110
±3904129609548
111396912960953970102
<4896129609548
0.0549611296095395393132
Oligohydramnion45614130985678100146192239278325354395464510532577624
12730141609539
(5.3%)27871416095215972112170190
13799141609539
(3.0%)38561416095215973112173192
NS495014160955188
Preeclampsia45615330984573116158195217258327374408430471
12730153609539
(5.3%)27871536095215972112170190
03826153609539
(0%)388315360952159119139
NS495015360955188
IQR45616560951769108
–579165609540
interquartile6331656095165880113136175216256279305321338372
range,101916560952362103143178192
NS122516560954983
–1322165609540
not137716560954181105
significant,14961656095284384125142162179213252293316331
*1841165609531
–1887165609540
calculation19411656095337390123163180220244260301342
in229816560951657
Group237016560954770110151192
22576165609537
from26271656095214584148
the27891656095246599
number290316560954181145185220243
of316116560954061
31323616560953769
pregnancies33191656095406497138179219261294311345373
(two370616560952143100140
pregnancies38611656095406396137178219260294310344372
that424816560952364105128
terminated43901656095245780143160201241265298338
in474316560951658
abortions481516560954081122145171187228269296
were512516560955689113146
excluded52851656095346810111715845617560954075115
from5861756095204483147
the7481756095236498
evaluation)86117560953468107124165205229245285327346
Tab.425200901135093144171
4.623200901135481
Neonatal731201701075593139185230256299318
outcomes1065201701074591117152196267305337
of1418201701074568
live-born150220170107193775112139186232258304
newborns1822201701074785148193239265311341
Group219921550985383129175223
12439215509842
(n220222550982468
=2287225509848
20235122550984387
)2454225509824
Group347421550985383129175223
23714215509842
(n348622550982468
=3571225509848
34)363522550984387110
p4868220509847
Neonatal45623750985497143190231259301323
mortality795237509868114143174216237258287330
02242237809539
(0%)229923780952159119139
03518237809539
(0%)357523780952159119139
NS484723780955188
Birth4562495098466897127174
weight646249509860102123170216245
(g)9072495098247093
2442216524980953975117154
±2336249809548
753240124980954076114
3285344124980953976114152
±3611249809548
457367624980953976114
<4733249809548
0.0000147982498095395393134175216252
Newborn45626150985497157205251280327
length80026150982062109156185231
(cm)104826150982458127149
45.821872618095397689130
±2335261809547
4.624002618095395393
49.834652618095397789129
±3612261809548
1.536772618095394989
<4753261809548
0.000148182618095395393134175211
Apgar45627350985198145187216
score68927350983370115144186
(one-minute)89227350982468114156184253274321367396437460
7.322122738095394686
±2315273809548
2.123812738095395287
9.134872738095395186
±3590273809548
1.036562738095394989
<4774273809548
0.00148392738095395393134170
Apgar45628550985198145187216
score68928550983370115144186
(five-minutes)8922855098244972113154182251272319365393435469492
8.622072858095395494
±2319285809547
1.423842858095394988
9.734832858095395190
±3590285809548
0.636562858095395393
<4774285809548
0.00148392858095395393134170
Preterm45729750984573116145186216285
delivery75829750984789111132173214244287
92198297809539
(45.0%)22552978095215895108148208228
23492297809539
(5.9%)35492978095215972110170190
<4794297809548
0.0148592978095395393129
Low45730950983985145
birth6193095098476897128174
weight810309509860101123169216244
10217830980953975
(50.0%)22703098095215998112152212231
13492309809539
(2.9%)35493098095215973111171191
<4774309809548
0.00148393098095395393134170
Mature457321509866108137182212254
newborn72732150984688149196243272319
10217832180953975
(50.0%)22703218095215998112152212231
32345832180953976
(94.1%)35513218095225899113148202222
<4794321809548
0.0148593218095395393129
NS45733380954982
–554333809540
not60833380954182105
significant7283338095274383125141161179212252293316
Tab.425355701135093144171
5.623355701135479
Maternal7293566010768113139176201248293311
outcomes1056356601074591117153196267306337
of1409356601074568
pregnancies1493356601074672108154200245291328346384416
Group121537040985383129175223
11455370409842
(n122938040982468
=1314380409848
19)137838040984383106
Group183537040985383129175223
22075370409842
(n184838040982468
=1933380409848
35)199738040984385108
p2573375409847
Maternal457392409866108137178208254296317
mortality457402409868114143174216237258287330
11233397709539
(5.3%)12903977095215972112170190
01879397709539
(0%)193639770952159119139
NS255339770955188
Heart45641440985496138167198
failure6704144098266788110156185227
41221414709539
(21.1%)12784147095215995105140194214
11853414709539
(2.9%)19104147095215973111171191
<2498414709548
0.0525634147095395393132
Supraventricular456426409842871351642062462873343623914124494954564364098216291
tachycardia56443640982870107153192228270299347368409
01259431709539
(0%)131643170952159119139
11853431709539
(2.9%)19104317095215973111171191
NS255343170955188
Ventricular45644840984887134163192213250296317358388
tachycardia45645840982870107153193228270299347368409
11233453709539
(5.3%)12904537095215972112170190
11853453709539
(2.9%)19104537095215973111171191
NS255345370955188
NS45647070954982
–553470709540
not60747070954182105
significant7274707095274383125141161179212252293316