Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome

Authors

  • Preeti Sharma Department of Obstetrics and Gynecology, GIMER and Dr RML Hospital, New Delhi, India
  • Renuka Malik Department of Obstetrics and Gynecology, GIMER and Dr RML Hospital, New Delhi, India
  • Neeraj Pandit Department of Cardiology, GIMER and Dr RML Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20180907

Keywords:

Adverse fetomaternal outcome, Cardiac risk factors, Heart disease in pregnancy

Abstract

Background: Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the predominant heart disease is still RHD (rheumatic heart disease), whereas in the developed countries congenital heart disease is more common.

Methods: This prospective observational study conducted in Department of Obstetrics and Gynecology in carried in PGIMER and Dr. RML Hospital, New Delhi from November 2015 to March 2017. 35 patients with heart disease were included in this study eight risk factors, four non-cardiac (age, parity, BMI and time of reporting to hospital) and four cardiac risk factors (etiology of lesion, type of lesion, prosthetic valve on anticoagulation and associated cardiac complication like atrial fibrillation (AF), pulmonary edema, pulmonary artery hypertension (PAH) were co-related with predefined indicators for adverse feto-maternal outcome. NYHA class, CARPREG score, modified WHO class were also co-related with adverse feto-maternal outcome.

Results: RHD is still more common than CHD in our population. No association was seen between any non-cardiac risk factor and adverse maternal outcome. Among cardiac risk factors, severe MS, severe PAH, NYHA class IV, AF, CARPREG score ≥2 were significantly associated with adverse maternal and fetal outcome. There was no maternal or fetal death in the present study.

Conclusions: Severe MS, severe PAH, AF, NYHA Class IV, CARPREG score ≥2 had positive predictive value for adverse feto maternal outcome in the present study which had no maternal or fetal mortality. Need for Preconceptional counselling which was seen to be totally absent in the present study is emphasized.

References

Nanna M, Stergiopoulos K. Pregnancy complicated by valvular heart disease: an update. J Am Heart Assoc. 2014;3(3):e000712.

Hiralal K, Chaudhuri S. Pregnancy complicated by maternal heart disease: a review of 281 women. J Obstet Gynaecol India. 2012;62(3):301-6.

Pushplata K. Cardiac diseases in pregnancy: a review. JIMSA. 2010;23(4):269-74.

Doshi HU, Oza HV, Tekani H, Modi K. Cardiac disease in pregnancy-maternal and perinatal outcome. J Indian Med Assoc. 2010;108:278-80.

Martins, Carvalho L. Risk prediction of cardiovascular complications in pregnant women with heart disease. Arquivos Brasileiros de Cardiologia. 2016;106(4):289-96.

Small MJ, James AH, Kershaw T, Thames B, Gunatilake R, Brown H. Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions. Obstet Gynecol. 2012;119:250-5.

Sui SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circ. 2001;104(5):515-21.

Regitz-Zagrosek V, Blomstrom-Lundqvist C, Borghi C, Cifkova R. 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). Eu Heart J. 2011;32:3147-97.

Sillesen M, Hjortdal V, Vejlstrup N, Sorensen K. Pregnancy with prosthetic heart valves-30 years nationwide experience in Denmark. Eur J Cardiothorac Surg. 2011;40(2):448-54.

Diao M, Kane A, Ndiaye MB, Mbaye A, Bodian M, Dia MM. Pregnancy in women with heart disease in sub­Saharan Africa. Arch Cardiovasc Dis. 2011;104(6)(7):370­4.

Wasim T, Amer W, Majrroh A, Siddiq S. Fetomaternal outcome of pregnancy with cardiac disease. J Pak Med Assoc. 2008;58(4):175-8.

Chumpathong S, Sirithaweesit C, Pechpaisit N, Suraseranivongse S, von Bormann B, Titapant V. Predictors for complications in pregnant women with heart disease, a retrospective study. J Med Assoc Thai. 2014;97(7):730-5.

Nicole J, Philippe M, Paul K, Lise-Andree M, Annie D, Francois M, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int J Cardiol. 2011;151(2):209-13.

Sliwa K, Libhaber E, Elliott C, Momberg Z, Osman A, Zuhlke L, et al. Spectrum of cardiac disease in maternity in a low-resource cohort in South Africa. Heart. 2014;100(24):1967-74.

Van Hagen IM, Boersma E, Johnson MR, Thorne S A, Parsonage WA, Escribano Subias P, et al. Global cardiac risk assessment in the registry of pregnancy and cardiac disease: results of a registry from the European Society of Cardiology. Eur J Heart Fail. 2016;18(5):523-33.

Pijuan-Domènech A, Galian L. Cardiac complications during pregnancy are better predicted with the modified WHO risk score. Int J Cardiol. 2015;195:149-54.

Pieper PG. Pre-pregnancy risk assessment and counseling of the cardiac patient. Neth Heart J. 2011;19(11):477-81.

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Published

2018-02-27

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Original Research Articles