Ahnert, Amy M, MD

Bettin, Margaret

Cabrera, Irena B, MD

Freudenberger, Ronald S, MD

Louis-Jacques, Adetola, MD

Quiñones, Joanne, MD, MSCE

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTNovel Collaborative Cardiology and Maternal FetalMedicine Practice – Continued Experience at theHeart and Pregnancy ProgramJoanne Quiñones MD, MSCELehigh Valley Health Network, Joanne_N.Quinones@lvhn.orgMargaret BettinUSF MCOM- LVHN Campus, margaret.bettin@lvhn.orgIrena B. Cabrera MDLehigh Valley Health Network, Irena_B.Cabrera@lvhn.orgAdetola Louis-Jacques MDLehigh Valley Health Network, Adet_F.Louis-Jacques@lvhn.orgAmy M. Ahnert MDLehigh Valley Health Network, Amy_M.Ahnert@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtQuinones, J., Bettin, M., Cabrera, I., Louis-Jacques, A., Ahnert, A., & Freudenberger, R. (2016, March 9). Novel CollaborativeCardiology and Maternal Fetal Medicine Practice – Continued Experience at the Heart and Pregnancy Program. Poster presented at: TheSELECT Capstone Project in the Kasych Conference Room, Lehigh Valley Health Network, Allentown, PA.AuthorsJoanne Quiñones MD, MSCE; Margaret Bettin; Irena B. Cabrera MD; Adetola Louis-Jacques MD; Amy M.Ahnert MD; and Ronald S. Freudenberger MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/select-program/72  ObjectiveRetrospective record review of women managed at HPP between March 2010 and December 2014. Univariate and multivariate statistical analyses were performed for group comparisons.Care of pregnant women with cardiac conditions requires expertise regarding the unique physiology of pregnancy. In order to streamline the care of these patients, the Heart and Pregnancy Program (HPP) was created. At HPP, pregnant women are seen simultaneously by cardiology and maternal fetal medicine (MFM) for consultation and management. The objective of our study is to describe the continued experience at this unique multidisciplinary program.© 2016 Lehigh Valley Health NetworkMethods 173 women were seen during the time period: 169 were pregnant, 1 was postpartum and 3 presented for preconception counseling. Average maternal age was 29.6 + 5.7 years (17 - 47 years). Most patients were Caucasian (n=140, 80.9%) and had private insurance (n=121, 69.9%). Referral indications included cardiac complaints without history of cardiac disease (n=49, 28.3%), known cardiac disease (structural/congenital, structural/acquired, or functional disease; n=96, 55.5%) and other high risk conditions (obesity, abnormal electrocardiogram; n=28, 16.2%). 26 women had undergone cardiac surgery (16.2%). Most women underwent echocardiography as part of their evaluation (n=123, 79.4%); eleven women underwent cardiac magnetic resonance imaging (6.4%). For the 140 women who delivered at our hospital, average gestational age at delivery was 38.8 + 1.7 weeks (31.3 – 41.6 weeks) and the cesarean rate was 41.4% (n=58). Average neonatal birthweight was 3390.8 grams + 482.7 (1690 – 5165). No significant adverse perinatal outcomes were noted.Results In our collaborative cardiology/MFM practice, most pregnant women had known cardiac disease. Imaging by echocardiography was common. The cesarean rate was slightly higher than the baseline rate in the United States. No significant adverse outcomes were noted. Our experience provides support for creating a joint model of care for pregnant women with cardiac disease.Conclusion1SELECT Program, University of South Florida Morsani College of Medicine, Tampa FL, 2University of South Florida Morsani College of Medicine, Tampa, FL,  3Lehigh Valley Health Network, Allentown, PANovel Collaborative Cardiology and Maternal Fetal Medicine Practice – Continued Experience at the Heart and Pregnancy Program  Baseline Characteristics by Disease CategorySymptoms Without History of Cardiac Disease(n=49)History of Either Structural (Congenital or Acquired) or Functional Cardiac Disease(n=96)High Risk of Cardiac Disease(n=28)p valueMaternal age (years + SD) 28.9 + 5.8 29.8 + 5.7 30.5 + 5.8 0.77Caucasian race (%) 41 (83.7) 80 (83.3) 23 (82.1) 0.78Married (%) 31 (68.9) 62 (68.9) 19 (67.9)  0.99Private insurance (%) 35 (71.4) 61 (63.5) 25 (89.3) 0.20Pre-pregnancy BMI (kg/m2) 27.0 + 6.0 28.2 + 7.5 34.8 + 9.7 <0.0001Nulliparous (%) 16 (32.7) 51 (53.1) 7 (25.0) 0.007Tobacco use (%) 6 (12.2) 13 (14.1) 1 (3.6) 0.32Gestational age at time of CHP evaluation (weeks + SD) 23.1 + 6.4 22.0 + 6.7 22.0 + 6.1 0.45Imaging by echocardiogram (%) 35 (75.5) 65 (67.7) 21 (75.0) 0.55Gestational age at delivery (weeks + SD) 39.2 + 1.5  38.6 + 1.7 38.9 + 1.7 0.12Cesarean delivery at LVHN (%) 13/49 (30.2) 33/96 (34.4) 12/28 (42.9) 0.20Intrapartum complications (%) 4/43 (9.3) 10/72 (13.9) 3/25 (12.0) 0.77Neonatal birthweight (grams + SD)  3441.2 + 427.0  3313.2 + 479.8  3447.4 + 610.5 0.28Joanne Quinones2, Margaret Bettin1, Irena Cabrera3, Adetola Louis-Jacques2, Amy Ahnert3, Ron Freudenberger3

Novel Collaborative Cardiology and Maternal Fetal Medicine Practice – Continued Experience at the Heart and Pregnancy Program

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Obstetrics & GynecologyNovel Collaborative Cardiology and Maternal FetalMedicine Practice – Continued Experience at theHeart and Pregnancy ProgramJoanne Quiñones MD, MSCELehigh Valley Health Network, Joanne_N.Quinones@lvhn.orgMargaret BettinUSF MCOM- LVHN Campus, margaret.bettin@lvhn.orgIrena B. Cabrera MDLehigh Valley Health Network, Irena_B.Cabrera@lvhn.orgAdetola Louis-Jacques MDLehigh Valley Health Network, Adet_F.Louis-Jacques@lvhn.orgAmy M. Ahnert MDLehigh Valley Health Network, Amy_M.Ahnert@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/obstetrics-gynecologyPart of the Obstetrics and Gynecology CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtQuiñones, J.,Bettin, M., Cabrera, I., Louis-Jacques, A., Ahnert, A., & Freudenberger, R. (2016, February 27). Novel CollaborativeCardiology and Maternal Fetal Medicine Practice – Continued Experience at the Heart and Pregnancy Program. Poster presented at: 4thInternational Congress of Cardiac Problems in Pregnancy, Las Vegas, NV.AuthorsJoanne Quiñones MD, MSCE; Margaret Bettin; Irena B. Cabrera MD; Adetola Louis-Jacques MD; Amy M.Ahnert MD; and Ronald S. Freudenberger MDThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/obstetrics-gynecology/3881Lehigh Valley Health Network, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Allentown, Pennsylvania; 2SELECT Program, University of South Florida Morsani College of Medicine, Tampa, Florida; 3Lehigh Valley Health Network, Department of Obstetrics and Gynecology, Allentown, Pennsylvania; 4University of South Florida Morsani College of Medicine, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tampa, FLorida; 5Lehigh Valley Health Network, Division of Cardiology, Department of Medicine, Allentown, PennsylvaniaNovel Collaborative Cardiology and Maternal Fetal Medicine Practice –          Continued Experience at the Heart and Pregnancy ProgramJoanne N. Quiñones MD MSCE1, Margaret Bettin2, Irena Cabrera MD3, Adetola Louis-Jacques MD4, Amy Ahnert MD5, Ron Freudenberger MD5© 2016 Lehigh Valley Health NetworkCare of pregnant women with cardiac conditions requires expertise regarding the unique physiology of pregnancy. The Heart and Pregnancy Program was developed at Lehigh Valley Health Network in an effort to coordinate and improve the antepartum care of women with either preexisting or new onset cardiac issues during pregnancy.  Lehigh Valley Health Network comprises of 5 hospital campuses with over 1160 acute care beds.  At HPP, either pregnant women or women seeking to conceive are seen simultaneously by cardiology (Dr. Ahnert) and maternal fetal medicine (MFM Dr. Quiñones) for consultation and management. The program’s initial patient care experience was reported two years ago at the Cardiac Problems in Pregnancy meeting in Venice, Italy. The objective of this follow-up study is to describe the continued experience at this unique multidisciplinary program.IntroductionConclusionIn our collaborative cardiology/MFM practice, most pregnant women had known cardiac disease. Imaging by echocardiography was common. The cesarean rate was slightly higher than the baseline rate in the United States. No significant adverse outcomes were noted. The Heart and Pregnancy Program was developed at Lehigh Valley Health Network in an effort to coordinate and improve the antepartum care of women with either preexisting or new onset cardiac issues during pregnancy.  During the office visits, physicians are able to discuss the care plans directly and provide interdisciplinary education to the patient.  This level of communication builds trust and is necessary for the most effective treatment in such a high risk population. Our experience provides support for creating a joint model of care for pregnant women with cardiac disease where women can be seen and counseled jointly by specialists in cardiology and maternal fetal medicine. Future quality improvement studies will address the types of joint counseling used, the level of patient satisfaction, the level of satisfaction among referring providers and maternal/neonatal outcomes.  Results173 women were either self-referred or sent to the program by their obstetrician or perinatologist: 169 were pregnant, 1 was postpartum and 3 presented for preconception counseling.  Average maternal age was 29.6 + 5.7 years (17 - 47 years). Most patients were Caucasian (n=140, 80.9%) and had private insurance (n=121, 69.9%). Indications for referral to the Heart and Pregnancy Program were as follows:  •  Cardiac complaints without history of cardiac disease      – Palpitations, near syncope, dizziness, chest pain/pressure •  Known cardiac disease      – Structural – acquired       •  Congenital heart disease       •  Valvular disease       •  Coarctation of the aorta     – Structural – congenital       •  Rheumatic heart disease       •  Mechanical valve      – Functional       •  Hypertension       •  Arrhythmia       •  Cardiomyopathy •  At high risk of cardiac disease during pregnancy.                Examples include:     – Obesity     – Abnormal electrocardiogram     – Marfan syndrome     – Mother undergoing transplacental therapy for fetal                    tachyarrhythmia26 women had undergone cardiac surgery (16.2%). Most women underwent echocardiography as part of their evaluation (n=123, 79.4%); eleven women underwent cardiac magnetic resonance imaging (6.4%). For the 140 women who delivered at our hospital, average gestational age at delivery was 38.8 + 1.7 weeks (31.3 – 41.6 weeks) and the cesarean rate was 41.4% (n=58). Average neonatal birthweight was 3390.8 grams + 482.7 (1690 – 5165). No significant adverse perinatal outcomes were noted.Table 1 describes the baseline characteristics of the women seen at HPP by disease category. Most women with a history of either structural (congenital or acquired) or functional cardiac disease were nulliparous when compared to the other groups (53.1%, p=0.007) and most women at high risk of cardiac disease had an increased BMI as high BMI was included as part of the definition of this category (p<0.0001).Table 1. Baseline Characteristics of the Women Seen at the Heart and Pregnancy Program by Disease Category Baseline Characteristics by Disease CategorySymptoms Without History of Cardiac Disease(n=49)History of Either Structural (Congenital or Acquired) or Functional Cardiac Disease(n=96)High Risk of Cardiac Disease(n=28)p valueMaternal age (years + SD) 28.9 + 5.8 29.8 + 5.7 30.5 + 5.8 0.77Caucasian race (%) 41 (83.7) 80 (83.3) 23 (82.1) 0.78Married (%) 31 (68.9) 62 (68.9) 19 (67.9) 0.99Private insurance (%) 35 (71.4) 61 (63.5) 25 (89.3) 0.20Pre-pregnancy BMI (kg/m2) 27.0 + 6.0 28.2 + 7.5 34.8 + 9.7 <0.0001Nulliparous (%) 16 (32.7) 51 (53.1) 7 (25.0) 0.007Tobacco use (%) 6 (12.2) 13 (14.1) 1 (3.6) 0.32Gestational age at time of CHP evaluation (weeks + SD)23.1 + 6.4 22.0 + 6.7 22.0 + 6.1 0.45Imaging by echocardiogram (%) 35 (75.5) 65 (67.7) 21 (75.0) 0.55Gestational age at delivery (weeks + SD)39.2 + 1.5 38.6 + 1.7 38.9 + 1.7 0.12Cesarean delivery at LVHN (%) 13/49 (30.2) 33/96 (34.4) 12/28 (42.9) 0.20Intrapartum complications (%) 4/43 (9.3) 10/72 (13.9) 3/25 (12.0) 0.77Neonatal birthweight (grams + SD)3441.2 + 427.0 3313.2 + 479.8 3447.4 + 610.5 0.280.45ABSTRACTObjective: Care of pregnant women with cardiac conditions requires expertise regarding the unique physiology of pregnancy.  In order to streamline the care of these patients, the Heart and Pregnancy Program (HPP) was created. Within this multidisciplinary practice, pregnant women are seen simultaneously by cardiology and maternal fetal medicine (MFM) for consultation and management.  The objective of our study is to describe the continued experience at this unique multidisciplinary program. Methods: Retrospective record review of women managed at HPP between March 2010 and December 2014.  Univariate and multivariate statistical analyses were performed for group comparisons.  Results: 173 women were seen during the time period: 169 were pregnant, 1 was postpartum and 3 presented for preconception counseling.  Average maternal age was 29.6 + 5.7 years (17 - 47 years).  Most patients were Caucasian (n=140, 80.9%) and had private insurance (n=121, 69.9%).  Referral indications included cardiac complaints without history of cardiac disease (n=49, 28.3%), known cardiac disease (structural/congenital, structural/acquired, or functional disease; n=96, 55.5%) and other high risk conditions (obesity, abnormal electrocardiogram; n=28, 16.2%).  26 women had undergone cardiac surgery (16.2%).  Most women underwent echocardiography as part of their evaluation (n=123, 79.4%); eleven women underwent cardiac magnetic resonance imaging (6.4%).  For the 140 women who delivered at our hospital, average gestational age at delivery was 38.8 + 1.7 weeks (31.3 – 41.6 weeks) and the cesarean rate was 41.4% (n=58).  Average neonatal birthweight was 3390.8 grams + 482.7 (1690 – 5165).  No significant adverse perinatal outcomes were noted.Conclusion: In our collaborative cardiology and MFM practice, most pregnant women had known cardiac disease and imaging by echocardiography was common.  The cesarean delivery rate was slightly higher than the baseline rate in the United States.  No significant adverse perinatal outcomes were noted.  Our experience provides support for creating a joint model of care for pregnant women with cardiac disease.Retrospective record review was performed for women managed at HPP between March 2010 and December 2014. Electronic medical records from outpatient visits and inpatient stays were reviewed.  Univariate and multivariate statistical analyses were performed for group comparisons.Methods

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1388&context=obstetrics-gynecology

Novel Collaborative Cardiology and Maternal Fetal Medicine Practice – Continued Experience at the Heart and Pregnancy Program

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network: LVHN Scholarly Works