DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20163439
Published: 2016-12-15

Study of pregnancy outcome in women with cardiac disease: a retrospective analysis

Kiran Pandey, Kavita Verma, Shruti Gupta, Uruj Jahan, Neha Kirti, Pundrik Gupta

Abstract


Background: Cardiac disease complicates 1% of all pregnancies. It is one of the 3 major indirect causes of maternal mortality in India. Objective of the study is to evaluate the maternal and fetal outcome in patients with cardiac disease in pregnancy.

Methods: A retrospective analysis was carried out in 117 pregnant women with known or newly diagnosed heart disease from January 2013 to December 2015 at a tertiary care hospital.

Results: In the present study, the incidence of cardiac disease was 0.8%. Majority 66 (56.4%) were of 23-27 years of age, 72 (61.5%) were primigravida. Mostly 84 (71.8%) belonging to New York Heart Association (NYHA) Class I and II. Rheumatic heart disease seen in 96 (82.1%) and congenital heart disease in 17.9% subjects. Among RHD Mitral stenosis was the most common, seen in 51 (53.1%) cases. Majority 78 (66.6%) had vaginal delivery and caesarean section in 28 (23.9%) cases. Most common maternal complication was anaemia seen in 54 (46.2%) cases, congestive cardiac failure complicated 23 (19.6%) cases. 18 patients required ICU care and maternal mortality in 6 cases (5.12%). The live births in (94.8%) cases, 33 (28.2%) babies required NICU admission and perinatal mortality was 7.7%.

Conclusions: Heart disease in pregnancy is a high risk condition and has a major impact on pregnancy outcome. Rheumatic heart disease being the prominent cardiac lesion. Fetomaternal mortality and morbidity can be reduced with proper antenatal, intrapartum and postnatal care in conjunction with cardiologist and neonatologist.


Keywords


Cardiac disease, RHD, Outcome, Pregnancy, Retrospective, NYHA class

Full Text:

PDF

References


Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Cardiovascular Disease In Williams Obstetrics. 24th edition. McGraw Hill Education; New York; 2010.

James, Steer, Weiner, Goink, Crowther, Robson. High risk pregnancy management option. In Cardiac disease in pregnancy. 4th edition: 2012;627-656.

Bhatla, Yadav, Mishra. The cardiac case. In Ian Donald’s practical obstetrics problems. 6th edition. BI Publications Pvt Ltd. India. 2010;103-126.

Davies GA, Herbert WN. Assessment and management of cardiac disease in pregnancy. J Obstet Gynaecol. 2007;29(4):331-6.

Burlingame J, Horiuchi B, Ohana P, Onaka A, Sauvage LM. The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system. J Perinatal. 2012;32:163-9.

Surge D, Blake S, Donald D. Pregnancy complicated by maternal heart disease at the National maternity Hospital, Dublin 1969-1978. Am J Obst Gyne. 1981;139(1):1-6.

Barbosa PJ, Lopes AA, Feitosa GS. Prognostic factors of rheumatic mitral stenosis during pregnancy and puerperium. Arq Bras Cardiol. 2000;75:215-24.

Sawhney H, Aggarwal N, Suri V, Vasishta K, Sharma Y, Grover A. Maternal and perinatal outcome in rheumatic heart disease. Int J Gynaecology Obstet. 2003;80:9-14.

Sheela CN, Karanth S, Patil CB. Maternal cardiac complications in women with cardiac disease in pregnancy. Int. J Pharma Biomed Res. 2011;2(4),261-5.

Koregeol M, Nina, Nayak R, Amritha. Maternal and perinatal outcomes of pregnancies complicated by cardiac disease. J Turkish German Gynaecol Assoc. 2009;10:30-4.

Vasu S, Stergiopoulos K. Valvular heart disease in pregnancy. Hellenic J Cardiol. 2009;50:498-510.

Bhatla N, Lal S, Behra G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac Disease in pregnancy. Int J Gynaecol Obstet. 2003;82:153-9.

Hsieh TT, Chen KC, Soong JH. Outcome of pregnancy in patients with organic heart disease in Taiwan. Asia Oceania J Obstet Gynaecol 2007;19:21-7 .

Kovavisarach E, Nuaplot P. Outcome of pregnancy among parturients complicated with heart disease in Rajavithi hospital. J Med Assoc Thai. 2007;90:2253-9.

Sermer M, Colman J, Siu S. Pregnancy complicated by heart disease: a review of Canadian experience. J Obstet Gynaecol. 2003;23:540-4.

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

Hanania G, Thomas D, Michel PL, Garbarz E, Age C et al. Pregnancy and prosthetic heart valves a French cooperative retrospective study of 155 cases. Eur Heart J. 1994;15:1651-8.

Suri V, Sawhney H, Vasistha K, Renuka T, Grover A. Pregnancy following cardiac valve replacement surgery. Int J Gynaecol Obstet. 1999;64:239-46.

Siu S, Sermer M, Colman J, Alvarez AN, Mercier LA, Mortan BC, et al. Cardiac disease in pregnancy (CARPREG) investigators. Prospective multicenter study of pregnancy outcome in women with heart disease. Circulation. 2001;104:515-21.