Intrapartum cardiac telemetry monitoring in patients with cardiovascular disease

BACKGROUND: There are no guidelines for cardiac telemetry monitoring during labor and delivery in patients with cardiovascular disease (CVD). We sought to identify factors influencing provider recommendations for intrapartum telemetry monitoring and associated outcomes. METHODS: This is a single-center, cohort study comparing cardiovascular outcomes during the antepartum, intrapartum, and postpartum periods between those who received telemetry and those who did not. Clinically significant arrhythmic events (CSAEs) were assessed in all patients. RESULTS: Among 717 pregnancies in patients with CVD, 94 (13.1%) had antepartum recommendations for telemetry. Type of CVD differed between those with and without telemetry recommendations (P < 0.001), with a higher proportion of individuals with arrhythmias in the recommended telemetry group. These pregnancies were also more likely to present with New York Heart Association (NYHA) Class ≥ 2 at enrollment (12.8 vs. 5.3%, P = 0.008), new antepartum arrhythmia (26.6 vs. 2.1%, P < 0.001), and greater use of beta blockers (55.3 vs. 27.9%, P < 0.001), anti-arrhythmic medications (16.0 vs. 2.1%, P < 0.001), or calcium channel blockers (8.5 vs. 2.1%, P = 0.002). Telemetry was used in 77 vaginal deliveries (10.7%) and all 261 cesarean deliveries. Only one patient monitored with telemetry experienced an intrapartum CSAE (0.3%). There were no CSAEs in patients not monitored on telemetry. CONCLUSIONS: Cardiac telemetry monitoring has a limited impact on the intrapartum management of patients with CVD. Further studies are needed to identify which patients may benefit most from intrapartum telemetry.