None listed
Conditions
Brief summary
Title: A Mother’s heart beats for two: to explore the current provision of evidence based practice, outcomes and ‘lived experience’ for women with cardiovascular disease during pregnancy. Background: Although cardiac disease complicates approximately 1% to 3% of pregnancies it is responsible for 10% to 15% of maternal mortality. This rate is expected to increase in the current environment of elderly primigravida and increased obesity and diabetes in pregnancy. This study will evaluate the current care and outcomes for women with pre-existent or newly acquired cardiac disease during pregnancy. Methods: The proposed research will include phase 1 :-an analysis of the documented care and outcomes from a retrospective medical record review (MRR) for women with congenital and / or newly acquired heart disease during pregnancy and postnatal follow-up. Aims: 1. Describe the current the clinical course, appropriateness of care, referral and outcomes for these women and babies in relation to evidence based clinical practice guidelines 2. Identify gaps in the clinical management across the course of pregnancy, delivery and on-going care. 3. Elucidate and describe the experience of women with cardiac disease during pregnancy, delivery and on-going care. a. Articulate the difficulties encountered by women with cardiac disease in pregnancy. b. Identify elements that will facilitate improved clinical course and positive outcomes for women with cardiac disease in pregnancy Conclusion: The outcomes of this project will provide baseline data for further research, recommendations for practice change and strategies to improvement the uptake of evidence based guidelines.
Interventions
Retrospective Medical Records Review (MRR).
2 groups defined as :
1. Pre-existing cardiac condition
2. Newly acquired cardiac condition during course of pregnancy.
Observations will include documented pre-conception care i.e. clinical , medication ,physical and psychosocial assessment, relevant history, cardiac investigations, cardiac education, planned care and delivery management (evidence based practice), through the continuum of pregnancy.
In this study the continuum of care will be ide
Retrospective Medical Records Review (MRR). 2 groups defined as : 1. Pre-existing cardiac condition 2. Newly acquired cardiac condition during course of pregnancy. Observations will include documented pre-conception care i.e. clinical , medication ,physical and psychosocial assessment, relevant history, cardiac investigations, cardiac education, planned care and delivery management (evidence based practice), through the continuum of pregnancy. In this study the continuum of care will be identified as the women’s journey in pregnancy through the healthcare system specifically , ante partium natal, intrapartium and post partium including any outpatient appointments with cardiac health practitioner. De identified data collected electronically via Auditmaker Data abstraction (collection) tool DAT that was developed based on SA perinatal guidelines. The tool was reviewed by experts and then pilot tested on 4 medical records. The kind of data collected will include: static, evolving, or cumulative data and therefore the structure of the DAT will need be reflective of this information. 1.Static data: snapshot in time, i.e. demographic data ( PC , Age , ethnicity, )and medical history therefore reflected as single record ( past medical and obstetric history ). 2.Evolving data: the information is collected over time, repeated measurement, vital signs and daily medication orders and so may require single records /pages per time interval ( labour and delivery stages and medications required at birth) 3.Cumulative data: collected over time, but not linked to specific points in time ( 12 lead ECGS and echocardiograms required during course of pregnancy, number and follow up in post natal period .
Sponsors
Sandra (Sindy) Kay Millington
Eligibility
Sex/Gender
All
Age
17 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients will be identified as women with newly acquired heart disease or pre-existent congenital heart disease. Women with the specific cardiac conditions will also be identified and documentation of the following : Ischemic heart disease( IHD) may include acute myocardial infarction (AMI) acute coronary syndrome (ACS) and angina, heart failure and cardiomyopathy, presence of arrhythmias during course of pregnancy and up to 12 months post delivery. The MRR will include patients admitted to the three SA health metropolitan tertiary hospitals where management of women with cardiac disease in pregnancy occurs during 2004 and 2014
Exclusion criteria
Medical records where patient is male gender. Convenience sampling of the available medical records within the specific time frame with women identified with cardiac disease in pregnancy within the three SA health metropolitan tertiary hospitals where management of these women occurs only. Private hospital :-unable to access medical records.
Outcome results
None listed