Cardiovascular complications following medical termination of pregnancy: An updated review

Abstract

BACKGROUND

Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described.

AIM

To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP.

METHODS

We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms “abortions” or “medical/legal termination of pregnancy” and “cardiac complications” or “cardiovascular complications”.

RESULTS

The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications.

CONCLUSION

In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.

Keywords: Cardiovascular complications; Termination of pregnancy; Infective Endocarditis; Stress cardiomyopathy; Outcome

Core Tip: The most common cardiovascular complications following the medical termination of pregnancy (MTP) are infective endocarditis (IE) and takotsubo cardiomyopathy (TTC). The most common organism identified in IE is group B Streptococcus and the tricuspid valve is the most common valve involved. TTC occurs most commonly in the first trimester after MTP. Spontaneous coronary artery dissection mostly presents with chest pain and the right coronary artery is the most common vessel to be involved. Bradyarrhythmia is the most common arrhythmia noted. These patients improve with appropriate medical management and mortality tends to be low.