Pregnancy outcome in rheumatic mitral stenosis patients with and without surgical correction: a prospective cohort study


  • Mustafa Bahloul Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut, Egypt
  • Armia Michael Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut, Egypt
  • Mansour Y. Kandeel Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut, Egypt
  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut, Egypt



Maternal morbidity, Mitral replacement, Perinatal outcome, Rheumatic heart disease


Background: The aim of the current study is to assess the maternal and fetal outcomes of pregnant females with and without surgically corrected mitral stenosis (MS).

Methods: A cross sectional study was carried out at Assiut Women's Health Hospital, Egypt between February 2016 and December 2016. All pregnant women diagnosed with rheumatic heart disease attending the antenatal care clinic were enrolled in the study. They were divided into two groups according to previous surgical correction of MS or not. All women were followed up during pregnancy till the end of puerperium. The primary outcome of the study was the difference in the rate of maternal cardiac complications during pregnancy between both groups.

Results: The study included 48 patients (39%) with surgically corrected MS and 75 patients (61%) with uncorrected MS. All cardiac complications were significantly higher in the uncorrected MS group (p <0.05). No difference between both groups in the mode of delivery (p=0.52). Postpartum hemorrhage is more common with the corrected MS group than the uncorrected group (25% vs. 9.3% respectively, p=0.003), while the need for postpartum admission to ICU was significantly higher in the uncorrected group (p=0.006). The mean birth weight was higher in the corrected MS group (p=0.000). The percentage of stillbirths and the rate of admission to PCU was higher in the uncorrected MS group (p=0.003).

Conclusions: Surgical correction of MS significantly improves the maternal and fetal outcomes of rheumatic heart pregnant females with MS.


Chapman AB, Abraham WT, Zamudio S, Coffin C, Merouani A, Young D et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int. 1998;54:2056.

Arnoni RT, Arnoni AS, Bonini RC, de Almeida AF, Neto CA, Dinkhuysen JJ et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg. 2203;76(5):1605-8.

Carapetis JR, Steer AC, Mulholland EK. The current evidence for the burden of group A streptococcal diseases (WHO/FCH/CAH/05.07). World Health Organization, Geneva; 2004.

Rheumatic fever and rheumatic heart disease: report of a WHO expert consultation-Geneva, 29 October-1 November 2001. WHO Technical Report Series; 2001:923.

Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46:223-30.

Stout KK, Otto CM. Pregnancy in women with valvular heart disease. Heart. 2007;93:552-8.

Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol. 2003;91:1382-5.

Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al. American Society of E, European Association of E. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1-23.

De Souza JA, Martinez EE Jr, Ambrose JA, Alves CM, Born D, Buffolo E, et al. Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J Am Coll Cardiol. 2001;37:900-3.

Sutton SW, Duncan MA, Chase VA, Marce RJ, Meyers TP, Wood RE. Cardiopulmonary bypass and mitral valve replacement during pregnancy. Perfusion. 2005;20:359-68.

Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med. 2000;160:191-6.

Curry R, Swan L, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol. 2009;21:508-13.

Reimold SC, Rutherford JD. Clinical practice. Valvular heart disease in pregnancy. N Engl J Med. 2003;349:52-9.

Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet. 2009;374:1271-83.

Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol. 2012;9:297-309.

Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382-94.

Bhandari S, Subramanyam K, Trehan N. Valvular heart disease: diagnosis and management. J Assoc Physicians India. 2007;55:575-84.

Baskerville CA, Hanrahan BB, Burke AJ, Holwell AJ, Remond MG, Maguire GP. Infective endocarditis and rheumatic heart disease in the north of Australia. Heart Lung Circ. 2012;21:36-41.

Lesniak-Sobelga A, Tracz W, KostKiewicz M, Podolec P, Pasowicz M. Clinical and echocardiographic assessment of pregnant women with valvular heart diseases-maternal and fetal outcome. Int J Cardiol. 2204;94:15-23.

Madazli R, Sal V, Cift T, Guralp O, Goymen A. Pregnancy outcomes in women with heart disease. Arch Gynecol Obstet. 2010;281(1):29-34.






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