Chronic rheumatic heart disease and congenital heart disease complicating pregnancy: a study of the cardiac events, the maternal and perinatal outcome during 2011-2013 at tertiary care centre

Authors

  • Pratibha Devabhaktuni Department of Obstetrics and Gynecology, Modern Government Maternity Hospital, Osmania Medical College, Hyderabad, Telangana, India Department of Obstetrics and Gynecology, CARE Institute of Medical Sciences, Hyderabad, Telangana, India
  • Sushma Manchala Department of Obstetrics and Gynecology, CARE Institute of Medical Sciences, Hyderabad, Telangana, India
  • Somaraju Bhupathi Raju Department of Cardiology, CARE Institute of Medical Sciences, Hyderabad, Telangana, India
  • Rajeev Menon Department of Cardiology, CARE Institute of Medical Sciences, Hyderabad, Telangana, India
  • C. Sridevi Department of Cardiology, CARE Institute of Medical Sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20202554

Keywords:

Cardiac events, Chronic rheumatic heart disease, Congenital heart disease, Maternal and perinatal outcome, Pregnancy

Abstract

Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.

Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.

Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically corrected by prosthetic heart valve were -11 (37.9%). In CRHD total corrected cases, by prosthetic heart valve and percutaneous balloon mitral valvotomy (PBMV) account for 51.7%. One patient had PBMV procedure during 5th month of present pregnancy i/v/o severe mitral stenosis with mitral valve area -0.8 cm2 and another patient had PBMV during her first pregnancy. In this study 42% were in NYHA class I. 14% were in NYHA class IV. CHF was seen in 10%. Termination of pregnancy was necessary in 6 with CHD and 5 with CRHD. There were 39 deliveries with one set of twins. All the babies were alive. Maternal mortality was confirmed in one case with Eisenmenger’s syndrome + HELLP syndrome. Live birth rate was higher in cases with NYHA class I/II than in those with NYHA class III/IV (82.8% versus 66.60%).

Conclusions: Management by a pregnancy heart team as per guidelines would reduce mortality.

References

Pratibha D, Kiranmai D, Rani UV, Vani GN. Pregnancy outcome in chronic rheumatic heart disease. J Obstet Gynecol India. 2009;59(1):41-6.

Arias F, Daftary SN, Bhide AG. Practical guide to high risk pregnancy and delivery: 3rd edition, section- 2, chapter - 20; 2012:522.

Cox PB, Gogarten W, Marcus MA. Maternal cardiac disease. Curr Opin Anaesthesiol. 2005;18:257-62.

Pijuan-Domenech A, Galian L, Goya M, Casellas M, Merced C, Ferreira-Gonzalez I, Marsal-Mora JR, et al. Cardiac complications during pregnancy are better predicted with the modified who risk score. Int J Cardiol. 2015;195:149-54.

Prasad AK, Ventura HO. Valvular heart disease and pregnancy. A high index of suspicion is important to reduce risks. Postgrad Med. 2001;110:69-72.

Asghar F, Kokab H. Evaluation and outcome of pregnancy complicated by heart disease. J Pak Med Assoc. 2005;55:416-9.

Regitz-Zagrosek V. The task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology. ESC. Eur Heart J. 2018;39:3165-241.

Uebing A, Steer PJ, Yentis SM, Gatzoulis MA. Pregnancy and congenital heart disease. BMJ. 2006;332(7538):401-6.

Ohuchi H, Tanabe Y, Kamiya C, Noritake K, Yasuda K, Miyazaki A, et al. Cardiopulmonary variables during exercise predict pregnancy outcome in women with congenital heart disease. Circ J. 2013;77:470-6.

Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49:2303-11.

Alanen J, Leskinen M, Sairanen M, Korpimaki T, Kouru H, Gissler M, et al. Fetal nuchal translucency in severe congenital heart defects: experiences in Northern Finland. J Matern Fetal Neonatal Med 2019;32(9):1454-60.

Hyett J, Perdu M, Sharland G, Snijders R, Nicolaides KH. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10-14 weeks of gestation: population-based cohort study. BMJ. 1999;318:81-5.

Pratibha D, Srilakshmi Y, Kiranmai D, Swathi G. Pregnancy in cases of congenital heart disease. J Obstet Gynecol India. 2010;60(1):33-7.

Kuijpers JM, Koolbergen DR, Groenink M, Peels KCH, Reichert CLA, Post MC, et al. Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: Focus on the use of prosthetic material. Eur Heart J. 2017;38:2048-56.

Kebed KY, Bishu K, Al Adham RI, Baddour LM, Connolly HM, Sohail MR, et al. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clin Proc. 2014;89:1143-52.

Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075-128.

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

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;80:9-14.

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

Tahira T, Tahir S. Pregnancy; outcome in cardiac disease. Prof Med J. 2012;19(2):145-9.

Waheed K, Sajjad N, Riaz U, Ejaz S, Malik M. Frequency of maternal complications in pregnancy with cardiac disease. Pak J Med Health Sci. 2012;6(3):613-5.

Arif MS, Arif A, Baqar S. Maternal and fetal outcome in pregnant and parturient women with cardiac disease. Pak Arm Forces Med J. 2013;63(1):38-41.

Rana A. Maternal cardiac diseases complication pregnancy: a review of 105 cases. J Inst Med. 2001;23:14-20.

Wasim R, Amer W, Majrroh A, Siddiq S. Foetomaternal outcome of pregnancy with cardiac disease. JPMA 2008; 58: 175-8.

Miao W, Miao Q. Pregnancy complicated by heart disease: clinical analysis of 116 patients. Life Sci J. 2013;10(1):69-72.

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. Circulat. 2001;104(5):515-21.

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.

Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulat. 2006;113(4):517-24.

Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37:893-9.

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Published

2020-06-25

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Original Research Articles