Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at tertiary level hospital of Uttarakhand
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20173261Keywords:
Cardiac disease, Peripartum cardiomyopathy, Rheumatic heart diseaseAbstract
Background: Cardiac disease is the most common cause of indirect maternal deaths and most common cause of death overall. It complicates 1% of all maternal deaths. The maternal and neonatal risks associated with pregnancy in women with cardiac disease receiving comprehensive prenatal care have not been well defined. Objective of present study was to evaluate the burden of cardiac diseases in pregnancy in our hospital, their clinical presentation, type of cardiac lesion, associated complications, maternal and fetal outcome.
Methods: A retrospective study was conducted in Obstetrics and gynecology department at Shri Guru Ram Rai Institute of medical and health sciences, Dehradun from January- 2013 to December-2015. All patients with cardiac diseases during pregnancy or developed during postpartum period were included in the study. Detailed Demographic profile of patients, mode of delivery, perinatal outcome, associated antenatal, intranatal and postnatal complications were analyzed in detail.
Results: There were 37 patients with cardiac disease during pregnancy in our study period. Out of these 32.4% were diagnosed during current pregnancy. Rheumatic heart diseases were seen in 54.05% patients and congenital heart disease seen in 35.1%. out of these 81.1% patients belonged to NYHA class I and II and 18.9% patients in class III & IV. Majority of patients (78.3%) had vaginal delivery. We observed 5.4% maternal mortality and 2.7% of neonatal mortality rate.
Conclusions: Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications. Multidisciplinary approach involving cardiologist, obstetrician and neonatologist improves fetomaternal outcome.
References
Nanna M, Stergiopoulos K. Pregnancy complicated by valvular heart disease: an update. J Am Heart Assoc. 2014;3(3):e000712.
Konar H, Chaudhuri S. Pregnancy complicated by maternal heart disease: a review of 281 women. J Obstet Gynecol India. 2012;62(3):301-6.
Leśniak-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. 2004;94(1):15-23.
Ahmed N, Kausar H, Lubna Ali R. Fetomaternal outcome of pregnancy with Mitral stenosis. Pak J Med Sci. 2015;31(3):643.
Sheela CN, Karanth S, Patil CB. Maternal cardiac complications in women with cardiac disease in pregnancy. Int J Pharm Biomed Res. 2011;2(4):261-5.
Hameed AB, Mehra A, Rahimtoola SH. The role of catheter balloon commissurotomy for severe mitral stenosis in pregnancy. Obstet Gynecol. 2009;114(6):1336-40.
Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Cotrufo M. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol. 1999;33(6):1637-41.
Sawhney H, Aggarwal N, Suri V, Vasishta K, Sharma Y, Grover A. Maternal and perinatal outcome in rheumatic heart disease. Int J Gynecol Obstet. 2003;80(1):9-14.
Bhandiwad A, Desai N, Kondareddy T. Maternal outcomes of rheumatic heart disease in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):802-6.
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-97.
Gottliebson WM, Border WL, Franklin CM, Meyer RA, Michelfelder EC. Accuracy of fetal echocardiography: a cardiac segment‐specific analysis. Ultrasound Obstet Gynecol. 2006;28(1):15-21.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N et al. Cardiac disease in pregnancy. Int J Gynecol Obstet. 2003;82(2):153-9.
