DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184977

A study of pregnancy outcome in patients with cardiac disease

Pradnya D. Kamble, Amarjeet Kaur Bava

Abstract


Background: Cardiac disease is a leading cause of maternal mortality and morbidity. Timely diagnosis and appropriate management can significantly improve the maternal and perinatal outcome.

Methods: This prospective observational study was performed over a period of 18 months at a tertiary care centre in Mumbai. A total of 100 women with heart disease were included in the study. The subjects were followed up during the antenatal, intrapartum and postpartum period to study the maternal and perinatal outcome.

Results: Out of 14791 confinements 100 consenting patients were included in the study. The incidence of heart disease came out to 0.9%. Rheumatic heart disease (RHD) was seen more commonly as compared to congenital heart disease (CHD) and peripartum cardiomyopathy. 64% patients delivered vaginally out of which 8% had instrumental delivery and 28% underwent a lower segment caesarean section (LSCS). 21% patients had cardiac complications like pulmonary edema, arrhythmias, sepsis, DIC etc. and there were 3 maternal mortalities. 58% of the babies were born low birth weight, 90.9% of the babies had an Apgar score of >7. 60% of the babies were born at term whereas 26% had a preterm delivery.

Conclusions: Patients of cardiac disease with pregnancy need to be managed at a tertiary care centre by a multidisciplinary team of doctors. Early diagnosis of heart disease and stringent management of complication is of utmost importance. Vaginal delivery is favourable and LSCS should be performed for an obstetric indication. Maternal heart disease leads to an increased incidence of preterm delivery and hence a joint care of neonatologist is mandatory in managing these patients.


Keywords


CHD, Maternal heart disease, MS, Peripartum cardiomyopathy, RHD

Full Text:

PDF

References


Launay D, Hachulla É. Cardiac and pulmonary scleroderma. Scleroderma. The Practitioner's Review. 2002;52(17):1901-7.

Silverman ME. A view from the millennium: The practice of cardiology circa 1950 and thereafter. J Am Coll Cardiol. 1999;33(5):1141-51.

Perloff JK. Systemic complications of cyanosis in adults with congenital heart disease. Hematologic derangements, renal function, and urate metabolism. Cardiol Clin. 1993;11(4):689-99.

Lewis G, Drife J, Clutton-Brock T. Maternal C into. Why Mothers Die: 2000-2002: the sixth report of the confidential enquiries into maternal deaths in the United Kingdom. RCOG. 2004.

WHO. Trends in Mternal Mortality: 1990-2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Heal Organ. 2014;56.

Puri S, Bharti A, Puri S, Mohan B, Bindal V, Verma S. Maternal heart disease and pregnancy outcomes. J Med Educ Res. 2013;15(1):7-10.

Sugrue D, Blake S, MacDonald D. Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland, 1969 to 1978. Am J Obs Gynecol. 1981;139(1):1-6.

McFAUL PB, Dornan JC, Lamki H, Boyle D. Pregnancy complicated by maternal heart disease. A review of 519 women. BJOG: An Int J Obstet Gynaecol. 1988;95(9):861-7.

Bangal VB, Singh RK, Shinde KK. Clinical study of heart disease complicating pregnancy. J Pharma. 2012;2(4):25-8.

Nagamani G, Bhavani K, Isukapalli V, Lagudu S. Heart disease in pregnancy prospective study from southern India. Int J Current Med App Sci. 2015;6(1):8-12.

Hiralal K, Snehamay C. Pregnancy complicated by maternal heart disease: A review of 281 women. J Obstet Gynecol India. 2012;62(3):301-6.

Avila WS, Rossi EG, Ramires JA, Grinberg M, Bortolotto MR, Zugaib M, et al. Pregnancy in patients with heart disease: experience with 1,000 cases. Clin Cardiol. 2003;26(3):135-42.

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.

Indira I, Sunitha K, Professor JA, Professor AP, Gynecologist CO. Study of pregnancy outcome in maternal heart disease. IOSR J Dent Med Sci Ver IV. 2015;14(7):2279-861.

Nqayana T, Moodley J, Naidoo DP. Cardiac disease in pregnancy. Cardiovasc J Afr. 2008;19(3):145-51.