DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162984

Pregnancy outcome in women with heart disease at a tertiary referral teaching center in Northern India

Kavita Gahlot, Punya Pratap Singh, K. Pandey

Abstract


Background: Pregnancy causes a significant burden on cardiovascular system due to hemodynamic changes therefore a diseased heart may not be able to adjust with extra load resulting in heart failure and even maternal mortality.

Methods: A prospective study was done in 50 women with heart disease over a period of 12 months from 2010 to 2011 at G.S.V.M. Medical College, Kanpur. At the first antenatal visit baseline data is recorded included age, parity, gestational age, NYHA class, co-morbid conditions, prior cardiac events, cardiac lesion (if already diagnosed), prior surgery/interventions, cyanosis and medications. A thorough clinical examination and investigations were done.

Results: Maximum numbers of patients (56%) were in the age group 20-24 years. 52 % of patients were primigravida and 48 % of patients were multigravida. Maximum numbers of patients (76.67%) were in the lower socioeconomic group. Chronic rheumatic heart disease (84%) was the most common type of heart disease followed by congenital cardiac disease (14%). Heart disease if diagnosed preconceptionally or during earlier period of gestation both maternal (8.9%) and foetal complications (22.8%) are lesser as compared to patients in whom diagnosis was made late. There is also the significant difference with majority of the foetal complications in group IV (80%) (preterm birth, IUGR and perinatal mortality) as compared to group I (14.2%).

Conclusions: Maternal and perinatal outcome in women with heart disease depends mainly on the functional cardiac status during pregnancy, the risk being greater in NYHA III and IV. Our study shows that surgical intervention or medical management in pregnancy improves the functional class and also improves the maternal and fetal outcomes. Interventions can only be successfully done either before pregnancy or during 2nd trimester. When patients were diagnosed before pregnancy we have enough time for counseling and treatment. Counseling further increase the compliance and acceptance for medical and surgical interventions.

Keywords


Heart disease, Maternal mortality, Neonatal mortality, NYHA, Rheumatic heart disease, Congenital heart disease

Full Text:

PDF

References


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.

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

Bhatla N, Lal S Behera G, Kriplani A, Mittal S. Agrawal N, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003;82(2):153-9.

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.

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;104:515-21.

Nercolini D, Guerios EE, Bueno R, Tarastchuk J, Andrade P, Pacheco A, et al. Mitral stenosis and percutaneous mitral valvuloplasty (part-I). J Invasive Cardiol. 2005;17:382-6.

Arnoni RT, Arnoni AS, Bonini RC, de Almeida AF, Neto CA, Dinkhuysen JJ, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg. 2003;76:1605-8.

Elkayam U, Bitar F. Valvular heart disease and pregnancy, part I - native valves. Am J Coll Cardiol. 2005;46:223-30.

Rani DP, Vani NG, Kiranmai D, Usha V. Pregnancy outcome in chronic rheumatic heart disease. J Obstet Gynecol India. 2009;59(1):41-6.