Singh T, Mishra AK, Vojjala N, John KJ, George AA, Jha A, Hadley M. Cardiovascular complications following medical termination of pregnancy: An updated review. World J Cardiol 2023; 15(10): 518-530 [PMID: 37900907 DOI: 10.4330/wjc.v15.i10.518]
Corresponding Author of This Article
Ajay K Mishra, FACP, MBBS, MD, Academic Fellow, Division of Cardiology, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Oct 26, 2023; 15(10): 518-530 Published online Oct 26, 2023. doi: 10.4330/wjc.v15.i10.518
Cardiovascular complications following medical termination of pregnancy: An updated review
Tejveer Singh, Ajay K Mishra, Nikhil Vojjala, Kevin John John, Anu A George, Anil Jha, Michelle Hadley
Tejveer Singh, Anu A George, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Ajay K Mishra, Anil Jha, Michelle Hadley, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Nikhil Vojjala, Department of Internal Medicine, Post-Graduation Institute of Medical Education and Research, Chandigarh 00000, India
Kevin John John, Department of Internal Medicine, Tufts Medical Center, Boston, MA 01212, United States
Author contributions: Mishra AK and Hadley M planned and formulated the study; Singh T and Vojjala N collected and analysed the data; Singh T, Mishra AK, John KJ, George AA, and Jha A completed the manuscript; Singh T and Mishra AK revised the manuscript; Mishra AK and Hadley M reviewed the manuscript; and Hadley M approved the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ajay K Mishra, FACP, MBBS, MD, Academic Fellow, Division of Cardiology, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com
Received: June 15, 2023 Peer-review started: June 15, 2023 First decision: August 10, 2023 Revised: August 22, 2023 Accepted: September 18, 2023 Article in press: September 18, 2023 Published online: October 26, 2023 Processing time: 126 Days and 4.7 Hours
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.
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.
