Pregnancy and heart disease: risk and predictors of obstetric complications

Authors

  • Cicily T. J. Department of Obstetrics and Gynecology, Government Medical College, Kottayam, Kerala, India
  • Sherin Sams Department of Obstetrics and Gynecology, Government Medical College, Kottayam, Kerala, India
  • Soniya C. Alphonse Department of Obstetrics and Gynecology, Government Medical College, Kottayam, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20172015

Keywords:

Heart diseases, Pregnancy complications, Pregnancy, Pregnancy outcome

Abstract

Background: Although the disease is limited to only 0.5 to 1.0 percent of pregnant women, it remains an important cause of maternal morbidity and even mortality and has a significant effect on fetal outcome. Pregnancy and the peripartum period are associated with important cardiocirculatory changes that can lead to marked clinical deterioration in the woman with heart disease. Objectives of present study were to comprehend the impact of heart disease during pregnancy, to study the maternal and neonatal outcomes of pregnancies in women with heart disease, to identify predictors of pregnancy related complications in women with heart disease and to refine the risk stratification and to assess the individual risk of each pregnant woman with heart disease.

Methods: It is a perspective study carried out at College Department of Obstetrics and Gynaecology, Govt. Medical, Kottayam from January 2012 to March 2014.

Results: The outcomes of the pregnancies in 100 women who presented with heart disease and received their obstetrical care were evaluated. A maternal cardiac event, neonatal event, or both occurred in 37 completed pregnancies. A cardiac event complicated 8 completed pregnancies. It includes 2 maternal deaths, one on 9th postnatal day in women with hypertrophic obstructive cardiomyopathy and another in women with rheumatoid mitral stenosis who died of congestive cardiac failure. Most cardiac events (75%) occurred in the antepartum period and were either heart failure or cardiac arrhythmia.

Conclusions: Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.

References

Cunningham, F Gary, et al. Williams obstetrics - 22nd Edition. USA: Mc Graw-Hill, 2005. ISBN: 0-07-141315-4.

Uri E, Norbert G. Cardiac problems in pregnancy: diagnosis and management of maternal and fetal heart disease. New York:Wiley-Liss, 1998. ISBN 0-471-16358-9.

ACOG technical bulletin. Cardiac disease in pregnancy. Technical Bulletin No 168, June 1992. Int J Gynecol Obstet. 1993;41(3):298-306.

Cleveland Clinic: Center for continuing education. The Cleveland Clinic Foundation. [Online] 2014. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/pregnancy-and-heart-disease/.

Uebing A, Steer PJ, Yentis M, Gatzoulis MA. Pregnancy and congenital heart disease. BMJ. 2006.

Douglas PZ, Braunwald E. Braunwald's heart disease: a textbook of cardiovascular medicine. WB Saunders; 2005.

Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46(2):223-30.

Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol. 2003;91(11):1382-5.

Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynecol Obstet. 2003;82(2):153-9.

Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37(3):893-9.

Hemmings GT, Whalley DG, O’Connor PJ, Benjamin A, Dunn C. Invasive monitoring and anaesthetic management of a parturient with mitral stenosis. Canadian J Anaesth. 1987;34(2):182-5.

Clark SL, Phelan JP, Greenspoon J, Aldahl D, Horenstein J. Labor and delivery in the presence of mitral stenosis: central hemodynamic observations. Am J Obstet Gynecol. 1985;152(8):984-8.

Tsiaras S, Poppas A. Mitral valve disease in pregnancy: outcomes and management. Obstet Med. 2009;2(1):6-10.

Kotekar N, Nagalakshmi NV. A rare case of peripartum cardiomyopathy posted for caesarean section. Indian J Anaesth. 2007;51(1):6.

Vinitha S. Medical and Surgical Diagnostic Disorders in Pregnancy. Jaypee;2003.

Pulmonary Hypertension. Heart Disease and Pregnancy. [Online] http://www.heartdiseaseandpregnancy.com/phy_ph_ms.html.

Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J. 2011;19(12): 504-8.

Kaneko T, Aranki SF. Anticoagulation for prosthetic valves. Thrombosis. 2013;2013.

SM SC, Sermer M, Harrison DA, Grigoriadis E, Liu G, Sorensen S et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation. 1997;96(9):2789-94.

Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006;113(4):517-24.

Downloads

Published

2017-05-25

Issue

Section

Original Research Articles