Predictors of maternal and fetal outcomes of pregnant women with mitral stenosis

Abstract

Background: Valvular heart disease, in particular mitral stenosis, is associated with unfavorable pregnancy outcomes. Data on maternal and fetal outcomes of pregnant women with mitral stenosis in Ethiopia as well as other sub-Saharan countries is scare. Method: A retrospective cross section study was conducted. Chart review of all 58 pregnant women with mitral stenosis admitted at Tikur Anbessa Specialized Tertiary Referral Hospital labor ward from January 2014 to December 2018 was done. Result: This study included 58 pregnant women with MS. The mean age of the participants was 27(SD,±4.5) years. The mean mitral valve area among the participants was 1.1cm. About 79% of cases had MVA of ≤1.5cm 2 and 55.2% had valve area of ≤1cm2. Fifty one (87.9%) patients had moderate to severe pulmonary hypertension the overall incidence of serious adverse pregnancy and peripartal outcome among the study participants was 44.8%. About 69% of patients had heart failure, from which 34.5% had NYHA class III and IV functional classes. Maternal death occurred in 4(6.9%) cases, whereas thromboembolism and ICU admission rates were 2(3.4%) and 3(5.2%) respectively. Neonatal complications including low birth weight, preterm delivery, abortions and still birth were 26.5%, 16%, 17.2% and 6.1% respectively. Mitral valve area was the main determinant of outcome (AOR=15, 2.50-90% CI, P=0.003). CONCLUSIONS: The overall incidence of serious adverse maternal and fetal events in pregnant mothers with MS was 44.5%. The incidence of maternal death was 6.8%. Mitral valve area was the main determinant of outcome (AOR=15, 2.50-90% CI, P=0.003)

Evaluation of Pregnancy Outcome in Women with Rheumatic Mitral Valve Stenosis

“…In present study, cardiac failure was found to be increased with the severity of mitral stenosis. similar to many studies 7,8,12,16 (table 5). Mitral valve area was the main determinant factor for maternal and fetal outcomes of pregnant women with MS in various studies.…”

“…Low birth weight babies is due to associated uteroplacental insufficiency leading to low uteroplacental blood flow. In our study the chances of lowbirth weight babies is high in comparison to study by Gebremedhin Y et al 12 , although the still birth rate is similar. This may be as majority of patients arrived late without any prior antenatal check up with small for gestational age babies and mostly had preterm delivery .…”

“…Among 31 women, 25.80% of patients developed cardiac failure in our study, however there was no mortality due to cardiac cause (table 1). The incidence of maternal death was 6.8% in a study from Ethiopia 12 as they had majority of patients with severe MS, whereas it was negligible in studies from California 13 and 2% in a study from Pakistan. 14 The negligible maternal mortality could be because of immediate management of Cardiac failure in our centre in collaboration with team of obstetricians and cardiologists.…”

“…Moreover, systolic and diastolic blood pressure also increase during each contraction. 12,13 All these changes can lead to pulmonary congestion, pulmonary hypertension, right sided dilatation and tricuspid regurgitation. These cardiovascular changes contribute to decompensation of a previously asymptomatic MS.…”

“…Mitral valve area was the main determinant factor for maternal and fetal outcomes of pregnant women with MS in various studies. 8,12 This all is due to haemodynamic shifts occurring during pregnancy and immediately postpartum .…”