Cardiac diseases in pregnancy and its feto-maternal outcome
Keywords:Cardiac disease, NYHA classification, Outcome, Pregnancy, RHD
Background: Cardiac disease complicates 1-3% of all pregnancies. Of this Rheumatic heart disease constitute 74% and congenital heart disease 26%.
Methods: A retrospective study of all patients with cardiac diseases delivered was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according the severity, NYHA classification, type of pathology, the maternal and perinatal outcome was assessed, and the maternal mortality and perinatal mortality was recorded.
Results: 84% patients belonged to age group 20-29 years. 8% were teen aged and 4% patients were elderly. 64% patients were either P0+0 or P0+1. 8% patients were P0+3 and 2% patient were P3+0. 74% patients had RHD. 26% had grade I, 40% had grade II, 20% patients had grade III and 14% had grade IV heart disease. The associated complications were anemia 46%, Respiratory tract infection 12%, pregnancy induced hypertension 2% and recurrent rheumatic fever 2%. 48% had normal vaginal delivery, 20% had forceps delivery and 32% had caesarean delivery. One mother died of heart failure. All patients of grade I (100%) had term delivery. 23.07% of grade I, 30% of grade II, 60% of grade III and 100% babies of grade IV mothers were of low birth weight (˂2.5 kg). Babies weighing ˂1.5 kg were seen in 5% grade II, 10% grade III and 42.85% mothers with grade IV disease. 2 of grade IV and each of grade I, II and III died.
Conclusions: Feto-maternal outcome can be improved with close supervision of obstetrician and cardiologist throughout the pregnancy by antenatal care, early diagnosis and management.
Klein LL, Galan HL. Cardiac disease in pregnancy. Obstet Gynecol Clin N Am. 2004;31(2):429-59.
Van Mook WNKA, Peeters L. Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac disease during pregnancy. Curr Opin Crit Care. 2005;11(5):435-48.
Anandaraja S, Kothari SS, Bahl VK. Management of valvular heart disease during pregnancy. Ind Heart J. 2005;A57(2):101-8.
Saving Mothers. A report of the National Committee on Confidential Enquiries into maternal deaths in South Africa (1999−2001) DOH. Pretoria: 162-74.
Nqayana T, Moodley J, Naidoo DP. Cardiac disease in pregnancy. Cardiovasc J Afr. 2008;19(3):145-51.
Asghar F, Kokab H. Evaluation and Outcome of Pregnancy Complicated by Heart Disease. J Pak Med Assoc. 2005;55(10):416-9.
Naidoo DP1, Desai DK, Moodley J. Maternal deaths due to pre-existing cardiac disease. Cardiovasc J S Afr. 2002;13(1):17-20.
Steer PJ. Pregnancy and contraception In: Gatzoulis MA, Swan L,Therrien J, Pantely GA, editors. Adult Congenital Heart Disease: Practical Guide. Oxford: BMJ/Blackwell Publishing; 2005. p. 16-35.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003;82(2):153-9.
Doshi HU Oza HV, Tekani H, Modi K. Cardiac disease in pregnancy-maternal and perinatal outcome. JIMA. 2010;5:108(5):278-80.
Leary PJ, Leary SES, Stout KK, Schwartz SM, Esterling TS, Maternal, Perinatal, and Postneonatal Outcomes in Women with Chronic Heart Disease in Washington State. Obstet Gynecol. 2012;120(6): 1283-90.
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21.
Siu 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.