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OP25.12: Cesarean deliveries: a mounting threat

Methods: We reviewed all deliveries at Duke University from 2002–2011 to identify parturients receiving treatment for malignancy. All pregnant women exposed to doxorubicin were selected for analysis. Maternal cardiac function of the cohort was compared to historic controls based on doxorubicin exposure level (5% incidence at 400 mg/m2). Cardiac dysfunction was defined as an abnormal left ventricular fractional shortening (FS%) or ejection fraction (EF). The Fischer’s exact test was used for analysis. Results: Twenty-four parturients underwent treatment for malignancy; fourteen of these utilized doxorubicin-based regimens. Malignancies were divided between solid tumors (62%) and hematologic (38%). Eight women had maternal echocardiograms performed in the peripartum period after exposure to doxorubicin. Cumulative dose exposure varied from 25 mg/m2 to 375 mg/m2. Four patients demonstrated evidence of mild (FS%) or pronounced (EF) cardiac dysfunction (OR 19, P = 0.001, 2-tailed Fisher Exact) when compared to historic controls. No maternal deaths occurred, however, one patient remains on a left ventricular assist device (LVAD) due to severe postpartum cardiomyopathy. Conclusions: Pregnancy should be considered a high risk factor for doxorubicin-induced cardiomyopathy. Maternal echocardiography should be considered for all parturients, exposed to doxorubicin, regardless of the exposure dosage.