763
PŮVODNÍ42522701004395143193242296315
PRÁCE75522701004489137177218
Adverse42533701004280117152176206242
obstetric68333701003876105133168195220236266
and96533701003472110
neonatal109133701003773112150185211247263
outcomes137033701003876103133171231266296
of168233701003858
pregnancy17563370100376196135173207245276313
in208633701001452
high-risk21543370100375290128153177193222256
women242633701005291151186224
with26663370100526894133
heart281533701003772107131160
disease29913370100385381117152181217
E822822701004183
|351227010018
VNITŘNÍ4268043010746106127172220280301
LÉKAŘSTVÍ748804301074185130188236280325378400
/11948043010731
Vnitř1270804301074693112140166
Lék.1456804301074083122140
2024;70(3):E4-E91615804301074487129169183224266291333354369411453481525568
/22288043010732
www.casopisvnitrnilekarstvi.cz442680430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
the425328301072876120
deliveries.564328301074993112130171215241260304338355
At937328301075379
the1034328301072876121
same1173328301073475149193
time,1385328301072746120164178
all158232830107416078
indications1679328301071866116134175216243262310359392
for208932830107247198
the2206328301072776120
delivery2344328301074993112131172215242285
per2647328301075095121
C.s.2787328301075167101118
were4253423010764107133175
declared615342301074992132151190216258307
as938342301074073
cardiac.1026342301074081106154172211251266
The1308342301074290134
striking145734230107346288107144163210258
discrepancy173134230107496799138164206255296343382424
in2171342301071865
mWHO22523423010773143200259
<25273423010753
III259634230107193755
classes266734230107395897130162206239
(64%425356301072466112177
vs619356301074175
0%)7113563010744112133
probably862356301074976123174215265284324
reflects120435630107276993116160201231266
the1488356301072776120
concern1625356301074187136176219245294
of1937356301074771
the2026356301072876120
attending216435630107416898141189238257305354
physicians2536356301075098137171189229248288336369
that425370301072876117144
these588370301072876121154199
patients806370301075091118137181229256291
are1116370301074168111
also124637030107416093141
too1406370301072875124
risky154937030107274679117159
and1728370301074189138
that1886370301072876117144
operative2049370301074898143170211238257298341
delivery2410370301074993112131172215241284
is2714370301071951
the2785370301072876120
best425384301075095128157
solution.607384301073382101149177196244293309
According940384301075393131178205253272320369
to1334384301072774
the1433384301072776120
ESC1577384301074285136
guidelines,1738384301074996115164208228246294338372388
planned2150384301075070110158206250300
delivery2475384301074993112131172215241284
per2784384301075095121
C.s.425398301075167102118
in560398301071967
them643398301072876120194
has854398301074888122
no992398301074997
maternal11063983010773114141183210258299318
benefit1441398301074994142186210230258
and1715398301074189138
leads1870398301071963103152185
to2072398301072874
earlier2163398301074484110129148191218
termination239839830107277096170189237277304323371420
of2834398301074872
pregnancy425412301075077120170218258306347389
and836412301074189138
lower996412301071967132175202
birth121941230107506996127175
weight14164123010764108127176224251
(1),16884123010724648195
which18044123010765114133173221
fully204741230107237291109150
corresponds2218412301074087114141184218267316365414447
to2687412301072774
our2783412301074896122
results.425426301072770103150169197232249
An6934263010752101
unfavorable813426301074795119161201248275317366386430
phenomenon1262426301075099143191239313358406454503
in1784426301071967
Slovakia1870426301074260109149190228249289
is2178426301071952
steadily2249426301073362105145194213232272
increasing2540426301071966107134176217250268316365
trend42544030107285598146195
to640440301072874
terminate73444030107287097171190238278305348
pregnancy1102440301074976119169217258306347389
in1511440301071966
women15974403010765113187231279
with1896440301076584112161
heart2076440301074993133159190
disease2286440301074967100144185218262
per2568440301074994121
C.s.2709440301075167101118
When5654543010775125170220
comparing812454301074088164214257284304353403
the1242454301072878123
classes1392454301074160102136170215250
mWHO16694543010775148207269
III-IV19654543010719385887108156
and2148454301074190141
mWHO23164543010775148207269
<26124543010754
III,26934543010720395874
we27954543010766110
found425468301072471119167217
the660468301072876120
most7994683010773122155184
pronounced1002468301074976123172220269317357400450
differences147046830107496891119162189232280320363397
in1885468301071967
neonatal1970467901105199150202249280327351
complications.233846790110409116822124526830935638841146251455228904683010716
Newborns4254823010757102167217266293342375
of825482301074772
mothers9214823010774123150198242269303
with1249482301076584112160
high1434482301074867116164
to1623482301072874
extremely1722482301074484114141184258302321361
high2108482301074867116164
risk229748230107264678116
had2438482301074889138
a26014823010741
significantly2667482301073351100148167191211425496301074082130156176216
lower659496301071967132176202
birth88049630107496895126174
weight.10724963010765109127177225251268
The1358496301074292136
prevalence1512496301075077120161202221265313354396
of1927496301074872
newborns2017496301074893158208257284333366
with2401496301076584112161
low2580496301071967132
birth273149630107496895126174
weight4255103010764107125173220246
as687510301074173
well7765103010764107126144
as935510301074173
the1024510301072875118
prevalence1158510301074976118157198217260307347388
of1562510301074771
preterm1649510301074975117144186212285
deliveries1950510301074891110128168210236255298331
were22975103010764107132175
significantly248751030107345199147165188207247287334360379418
higher.425524301074968118166211238251
We7035243010775117
observed847524301074899133178205250294345
worse12195243010765114141176221
results1467524301072771105153172200236
in1730524301071968
these1824524301072978123157202
parameters2053524301075092119161236281309353380415
than2494524301072978119168
in2689524301071967
the2783524301072877122
ROPAC4255383010746106152199249
registry700538301072770120139172201228271
(3).99853830107246687101
The1125538301074292136
prevalence1288538301075077120161202221265314354397
of1711538301074873
low1810538301071968133
birth196953830107506995127175
weight21705383010766109128177225252
and2449538301074189139
preterm2614538301075077120148191217292
deliveries425552301074993112131172215241261304338
was7825523010765107140
equally941552301074494142182201220260
20.4%1220552301074487102146210
in1450552301071966
our1536552301074896122
total1677552301072875102144162
cohort1859552301074086135184211242
(vs212055230107246397
11.7%223655230107447889132198
and2454552301074089138
15.8%261155230107448296142208
in2838552301071967
ROPAC,4255663010745106152199248264
respectively).714566301072669103152197238269287328372391431454467
In1205566301071967
the1297566301072876120
ROPAC14425663010745106152199248
registry,1715566301072669119138170199226269281
congenital2020566301074187136185229277296324365384
heart2429566301074892132159190
disease2643566301074968101145185218262
(CHD)425580301072372126183204
was6455803010764104136
associated796580301074173105152192210249275317365
with1177580301076482109156
spontaneous1349580301073381128176202242289332379426458
preterm1823580301074874116143184210283
birth212158030107496793123170
(OR2306580301072381125
[odds2447580301072367116164196
ratio]265958030107266692110157178
=28525803010753
1.8,42559430107435498114
95%554594301074486149
CI719594301075068
[confidence803594301072360106153176195243287334373415
interval]123459430107186591133158201242260284
=15345943010753
1.2-2.7).160259430107445499124162176218242255
Complex1872594301075197170218237280319
CHD22075943010750105162
was23855943010764105137
associated2538594301074073105153193211250277318367
with425608301076585113161
small-for-gestational-age6136083010733107148167185213238286313337389433467496538565584632681722741769810859903
neonates1543608301074893142191232259301335
(OR1905608301072483129
=20606083010754
2.3,2140608301074460105120
95%2286608301074487152
CI2464608301075270
=25616083010753
1.5-3.5).2641608301074455100128169184229252265
Jastrow425622301073172105134161208272
et715622301074371
al.80362230107416076
reported896622301072770119169196227269319
preterm1232622301075077120148190217291
delivery1540622301074994113131172215242285
in1842622301071967
16.7%1926622301074483100143209
of2152622301074872
3122241622301074483120
pregnancies2378622301075077120170218259307347366410443
in2839622301071966
women4256363010765113187231279
with725636301076584113161
heart907636301074892132159190
disease1118636301074967100144184218262
(4).140163630107246587100
Toprak1522636301074285135162203241
et1784636301074472
al.187763630107416076
found1974636301072371119167216
an2211636301074189
identical2321636301071968112161187206246288307
finding264963630107244391141159207257
as425650301074173
in515650301071866
our597650301074895121
group735650301074874121168217
–9696503010744
a10306503010740
significantly1086650301073452100148166190209249290337364383422
higher1524650301074866115163206232
prevalence1773650301074976118158199218261309349391
of2180650301074872
preterm2268650301074976118146188214287
deliveries2572650301074892111129169212238257301334
in425664301071967
women5166643010765113187231280
with820664301076584112161
CHD10056643010752108166
and1195664301074189139
mWHO13586643010774146203264
classes164766430107405999133166210244
III-IV19166643010719375684105151
than2092664301072876117165
in2281664301071967
mWHO23736643010773145203264
classes2661664301074059100133166211244
I-II4256783010719476887
(5).53067830107246689102
Also650678301075372105153
in822678301071866
the907678301072776120
Mexican10456783010770115154173214255303
group1367678301074975122170220
(3991605678301072466108153
births)177667830107506995126174207229
the2023678301072876120
association2162678301074074107155197215256283302350398
between2579678301074994122189233278326
mWHO4256923010774146203264
class712692301074059100133166
and902692301074089138
preterm1063692301075077120148190217291
deliveries1377692301074993113131172215242261305338
was17396923010765106139
confirmed1902692301074086135159178205279323373
(6).229969230107236588101
Suwanrath2423692301074289154196244270312339387
et2833692301074472
al.42570630107416076
analysed517706301074189130149189223267317
331851706301074486124
cases992706301074082115159193
of1202706301074872
pregnant1291706301074976119169217258306333
women16417063010765112187231279
with1937706301076584112160
heart2114706301074993133159190
disease.2321706301074968100145185218262277
Adverse26157063010753101142185212246290
fetal42572030107246795136155
outcomes600720301074896125163210284328362
including982720301071967107126173223241289339
preterm1341720301074976119147190216290
delivery,1652720301074893112130171214241284296
low1968720301071967132
birth212072030107496995126174
weight,23147203010765109127176224251268
small26027203010733106147166185
for280772030107237198
gestational425734301074993126155196223242290338379398
age839734301074190134
and990734301074088138
neonatal1144734301074892141190230257298317
intensive147873430107186693135183216234275318
care1813734301074081107150
unit1980734301074795114142
admission2138734301074190163182214248266314362
were25177343010764108134177
significantly271073430107345210114916742574830107244384125173200219259
increased703748301071966107134176217250294344
in1066748301071967
mWHO11517483010774146203264
classes143474830107405999133166210244
III169774830107193756
and1772748301074189138
IV.192974830107196576
They2024748301074292136176
concluded2218748301074087136176195242292336386
that2623748301072776116143
the2785748301072876120
mWHO4257623010774146203264
classification71376230107405999133166184208228268310337356404452
is1189762301071952
useful1265762301074881125149197216
not1505762301074997124
only1653762301074897116156
for183376230107247198
obtaining1955762301074898126167186233252300349
a23287623010741
cardiovascular2393762301074082108156175223263305338379426445486512
risk304732830107274680118
assessment3192328301074175108153187221295340389416
in3635328301071968
pregnant3729328301075178121172221262311338
women40943283010765114189234282
with4403328301076685114163
heart4593328301074893134161192
disease4812328301074968101146187221265
but5104328301075099128
also525932830107416093142
for5428328301072472100
predicting3047342301075077120170188229259278326375
adverse3442342301074090131174201235279
fetal374134230107246795136155
outcomes3916342301074896124163209283328361
(7).429734230107246892105
Neonatal31873563010759105156207249278321341
mortality35563563010775126154187230250269299343
did3927356301075070121
not40763563010750100129
occur4233356301074992132182210
in4470356301072070
our4568356301074999127
cohort.4722356301074290141191220252269
In5019356301072070
the5117356301072878124
ROPAC52693563010747110158207258
registry,3047370301072770121139173202229272284
foetal3358370301072371117145187206
mortality35903703010775123151182224243262290333
occurred3949370301074990129178204232275326
in4301370301071967
1.7%439537030107445599165
and4587370301074189139
neonatal4753370301074893142192233260302321
mortality51003703010775124151182224243262290333
in5460370301071967
0.6%,3047384301074460105171188
both32613843010750100128176
higher3464384301074867117165210237
than3727384301072877118166
in3920384301071967
the4014384301072876121
normal4162384301074897124199240260
population44483843010750100150199218259287306354403
(8).487838430107246789103
Italian500738430107194789108127168216
authors5250384301074189117166215242277
reported3047398301072770120169197228271321
the3395398301072876121
single-center3542398301073452101150169214243286329377404447474
experience4042398301074484135180207226270319360402
in4471398301071967
514564398301074584
pregnancies4674398301075077121171220261309350369413447
of5147398301074873
women52463983010765113188233281
with3047412301076584112161
cardiovascular3228412301074081108156175223263304338378426445486512
disease.3760412301074968101145185218262277
There4058412301074191135162205
was42834123010765107140
no4443412301074897
neonatal4560412301074893142190231258299318
mortality,48994123010773122149180221240259287329341
just5260412301071967100129
like540941230107193775118
in3047426301071967
our3133426301074896123
study3276426301073362110160200
group3495426301074976123171221
(9).373542630107246587101
The3187440301074292136
proportion3344440301075077124174223250281300348397
of3762440301074872
extremely3856440301074383114141183257301321361
high-risk4238440301074967116164192220239272309
pregnancies4569440301075077120170218258306347366409443
in5034440301071866
the5122440301072876120
mWHO52644403010773145203264
class3047454301074059100133166
IV3236454301071965
is3323454301071952
generally3397454301074993142186212254273291331
increasing.3751454301071967107134177217250268316365381
It4155454301071947
was42244543010765106140
only4386454301074897116156
0.7%4564454301074459102168
in4755454301071966
the4844454301072876120
ROPAC49864543010746107152199249
registry5257454301072770120138171200227270
in3047468301071967
the3141468301072877122
years3289468301074084125152186
2007-2010,3502468301074488134176199238282322362377
but3906468301075099128
already406146830107416086130171221261
10.9%4349468301074484100143211
in4587468301071967
the4681468301072877121
years4829468301074084125151186
2015-20185042468301074488128166194233277317357
(3).542546830107256789102
Analogously,30474823010752100141159207257305353385404443455
in3518482301071966
our3601482301074795121
group3738482301074975122170219
(years3973482301072462105145171205
2011-2022),4194482301074487126161183222264306349371384
12.5%459548230107438096140204
of4815482301074871
pregnant4903482301074976118168216256304330
women52504823010764111185229277
were30474963010765108135178
in3245496301071967
mWHO33324963010773145202263
class3615496301074059100133166
IV.380149630107196677
These3898496301074291136169214
mothers41314963010774123150198242269303
have4454496301074889129172
an4646496301074189
extremely4755496301074483114141184257301321361
high5136496301074867116164
risk532049630107264578116
of5456496301074872
maternal30475103010773113139181207255295314
mortality33775103010772120146177217236254281323
or3716510301074774
severe3806510301073376116159185227
morbidity40495103010773120147196215263281309350
(40-100%).4415510301072465109139177215260327348360
According4791510301075291129175202249267314363
to5170510301072773
the5259510301072775118
ESC5393510301074284134
guidelines,3047524301074996115164208228246294338372388
pregnancy3456524301075077120170218259307347390
is3867524301071952
contraindicated3940524301074187136163189231250297347366406447474517567
for452952430107237198
them,4648524301072876120194210
and4879524301074189139
if5039524301071943
it5104524301071846
occurs,5172524301074889128176202236252
its544652430107194782
termination304753830107287097171190238278305324372421
should3486538301073381129178196246
be3749538301075095
considered3862538301074086135168186236280306349399
(1).42795383010724638194
Even4391538301074282125173
for458253830107247198
women46985383010765112187231279
in4995538301071966
mWHO50795383010774146203264
class536153830107405999133166
III,30475523010719385773
the3147552301072877122
risk329555230107274780118
is3440552301071952
high:3519552301074867117165180
19-27%3726552301074483113152194261
(1).40135523010724658396
Nevertheless,41365523010758103144188214246295339359403438471488
in4650552301071968
our4745552301074897123
experience,4895552301074484135181207227271320361404419
most53415523010774123157186
pregnancies3047566301074975118167214254301341359402435
in3498566301071966
mWHO35795663010773144201260
classes385556630107405898131164207240
III-IV41115663010719375583103149
were42755663010765107133175
intentional446656630107196692134181207226273321361379
and4861566301074088136
not5013566301074895122
accidental.5151566301074080118136185228275301342361376
According3187580301075392131178205253271319369
to3574580301072875
the3667580301072876120
ESC3806580301074285136
guidelines3961580301074996115164208227246293338371
all435158030107416078
women44485803010765112187231279
in4746580301071866
mWHO48315803010773145203264
classes5113580301074059100133166210244
III-IV53765803010719375685105152
should3047594301073481130178197246
be3311594301075095
monitored34245943010774122171190218264291334384
throughout3827594301072776102149197247295343391419
the4265594301072776120
pregnancy4403594301075077120170218259307347389
in4811594301071966
expert4896594301074383133178204235
centers5150594301074082130157200226261
for542959430107237198
pregnancy3047608301075077120171219260308349392
and3465608301074190139
cardiac3631608301074082108157176216257
disease.3914608301075068101146186220264279
The4220608301074292136
deliveries4383608301074993112131172216243262306340
are4749608301074168111
also488760830107416093141
to5055608301072875
be5156608301075095
carried5278608301074082108136155199249
out3047622301074998128
in3202622301071968
these3298622301072878123158203
centers3529622301074184134162205233268
(1).38246223010725668498
Significantly3949622301074362112162181206226268310360388408449
worse44256223010766115143179224
obstetric46766223010749101135165209238266286327
and5031622301074191141
neonatal5200622301074994145195237265307327
outcomes3047636301074896124163209284328362
in3426636301071967
mWHO35116363010774145203264
III-IV37926363010719385785106152
classes3962636301074059100133166210244
found4224636301072371119167217
in4458636301071967
our4543636301074896122
study4683636301073463111160200
are4901636301074167110
in5029636301071967
accordance5114636301074181120166193242282330371413
with3047650301076686115165
this323965030107287897131
statement.3397650301073464107135178254299348376393
For3818650301074290118
pregnant3963650301075179123174224265315342
women43336503010766115191236286
with4646650301076686115165
cardiac4838650301074183111160179221262
diseases5128650301075069103148189224269304
in5459650301071968
mWHO30476643010774146203264
classes3331664301074059100133166211244
<35966643010753
III,36706643010719375672
follow-up376266430107247191109158222250299349
and4131664301074189139
delivery4290664301074993112131172215241284
can4595664301074081129
be4745664301074994
performed4860664301074994121148195222296341391
in5271664301071967
local5358664301071967109150169
or3047678301074875
referral314267830107266993136163190232251
hospitals3412678301074897130180199227268287320
(1).37516783010724648295
The3187692301074292136
mWHO33436923010774146203264
classification3627692301074059100133167185209229269310337356404453
is4100692301071952
designed4172692301074993127145194242286336
to4529692301072874
predict4624692301074976119169188228259
maternal49036923010774114142184211259300319
risk.524269230107274679117135
van5397692301074182130
Hagen3047706301075797146190238
et3302706301074371
al.338970630107416076
evaluated3481706301074484126144192232259301351
the3849706301072876120
potential3985706301075099126168216243262302320
of4322706301074872
the4410706301072876120
mWHO45467063010774146203263
classification482670630107405999132165183207227267308335354402450
for529370630107237198
the5407706301072876120
prediction3047720301074975116165183222251269316363
of3425720301074771
obstetric3511720301074796128156197224250268307
and3834720301074086134
fetal398472030107236592132150
complications4150720301073984157205223241280320346364411458490
in4656720301071865
women47367203010764110182225272
with5024720301076382109156
structural519572030107336187134173202249274315333
heart3047734301074892133159190
disease.3256734301074968100145185218262277
There3552734301074292136163206
were37777343010765108135178
27423974734301074485123164
pregnancies.4158734301074976119169217258306347365409443460
The4637734301074291136
mWHO47927343010774145203264
classification507573430107405999133166184208228268310337356404452
performed3047748301075095121148196222297341391
poorly3463748301074999148175194234
in3722748301071967
predicting3813748301075077120170188229259278326375
obstetric4213748301074898131160203231257277317
(c-statistic455574830107236184118147188215234267296314355
=49347483010754
0.60)5013748301074459104148171
and5209748301074189138
fetal537274830107236795136155
events3047762301074484128176203237
(c-statistic330476230107246184118147189216234267296315355
=36797623010754
0.56)3752762301074460104147170
(10).3942762301072363103126139
Outcome14808970935397124157200264303
Odds36968970935398142175
Ratio38868970934483111131174
(95%40758970932365106172
CI)4262897093446589
p-value45938970934569108147168211251
mWHO1803289108357115159206
<2023289108341
III20782891083173350
mWHO2215289108357115159206
III24352891083163349
-2498289108321
IV253328910831655
16.037581347090387692130
(3.039041347090215975113
–4033134709037
85.5)40861347090387692130151
<4628134709044
0.0146881347090385492130
33.037581677090387692130
(3.839041677090215975113
–4033167709037
290.2)408616770903876115130168189
<4628167709044
0.0146881677090385492130
13.137582007090387692130
(2.439042007090215975113
–4033200709037
70.1)40862007090387692130151
<4628200709044
0.0146882007090395492130
22.737582336090387692130
(1.339042336090215975113
–4033233609037
409.0)408623360903876115130168189
<4628233609044
0.0546882336090385492130
1,021242590068294069
10,02576259006829576998
100,03028259006829578698126
1000,034792590068295786115126155
Delivery110923370905087104121157194218253
per137723370904380104
Caesarean149723370904379116145181205242278318
section183023370902967100124141182223
Preterm155620020904064101125162186248
delivery18202002090427996114149186210245
Low154616680903576132
birth16941668090426084109151
weight186116680905592110152194218
Unmature146913340904890152188213255279317
newborn180213340904179134177218242284
OR369825850754376
Fig.42560901134873125152
1.60460901135479
Odds710618010758104150179
ratios9056180107266995113158188
(OR)110961801072480125147
of127261801074568
selected13566180107326987126163191227273
obstetric164561801074591121147184210236254291
and195261801074692137
neonatal210561801074785130177222248291309
outcomes243161801074591116152195267305336
of278461801074567
pregnancies286861801074571108153199244291328346384415