A study of maternal and fetal outcome in cardiac disease in pregnancy at tertiary care center
Keywords:CHD, MS, MR, RHD
Background: Cardiac disease complicating pregnancy is an indirect cause of maternal mortality. The incidence of cardiac disease during pregnancy has remained stable for many years even with significant decrease in the occurrence of rheumatic heart disease (RHD) as this decrease is being compensated by significant increase of pregnancy in women with congenital heart disease (CHD). Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy and to assess the obstetrical outcome.
Methods: A retrospective study carried out in 32 women with cardiac disorders at a tertiary care centre during the period of 5 years.
Results: In the present study the incidence of cardiac disease in pregnancy was observed to be 0.21%. With 62.6% rheumatic, 21.8% congenital being and 15.6% peripartum cardiomyopathy. Among rheumatic valvular heart disease, mitral valve stenosis was most common followed by mitral regurgitation and tricuspid regurgitation. Non-cardiac complications like pre-eclampsia and anaemia were also noted. No of vaginal delivery were higher compared to caesarean (26 versus 6). Adverse perinatal outcomes in form of preterm, NICU admission and perinatal death were also noted.
Conclusions: A cardiac disease has a major impact on pregnancy. It is a multidisciplinary teamwork to have optimal maternal and foetal outcome in women with cardiac disease. Hence, constant vigilance is required throughout antenatal, intrapartum and postpartum period to avoid adverse outcomes.
Uebing A, Steer PJ, Yentis SM, Gatzoulis MA. Pregnancy and congenital heart disease. Br Med J. 2006;332:401-6.
Vera RZ, Carina BL, Claudio B, Renata C, Rafael F, Jean MF. ESC guidelines on the management of cardiovascular diseases during pregnancy. Eu Heart J. 2011;3147-97.
Bansode BR. Pregnancy and heart disease. Assoc Physicians Ind. 2010;773-6.
Sawhney H, Aggarwal N, Suri V, Vasishta K, Sharma Y, Grover A. Maternal and perinatal outcome in rheumatic heart disease. Int J Gynaecol Obstet. 2003;9-14.
Konar H. Medical disorders in pregnancy: who should see the woman?. J Ind Med Assoc. 2004;102:131.
Sheela CN, Karanth S, Patil CB. Maternal cardiac complications in women with cardiac disease in pregnancy. Int J Pharm Biomed Res. 2011;261-5.
Vijaya BC, Rekha GD, Preeti L. Maternal outcome in heart disease in pregnancy. RRJMHS. 2014;61-6.
Mohamed R, Awni G. Maternal and fetal outcome in women with rheumatic heart disease. Arch Gynecol Obstet. 2016;273-8.
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multi- center study of pregnancy outcomes in women with heart disease. Circ. 2001;104(5):515-21.
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;685-94.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac disease in pregnancy. Int J Obstet Gynecol. 2003;82:153-9.
Indira I, Sunitha K, Jyothi. Study of pregnancy outcome in maternal heart disease. IOSR J Dental Med Sci. 2015;14(7):6-10.
Prameela. Clinical study of cardiac disease complicating pregnancy. Int Med J. 2015;115-7.