Pregnancy and heart disease: risk and predictors of obstetric complications

Abstract

INTRODUCTIONMaternal cardiac diseases complicate 1% of all pregnancies and are responsible for about 15% of all maternal deaths. The incidence of cardiac disease during pregnancy has remained stable for many years since the significant decrease in the occurrence of rheumatic heart disease in the last few decades has been compensated by a significant increase of pregnancy in women with congenital heart disease. In developed countries, survival of newborns affected by congenital heart disease is about 85% in many cases as a result of complex surgical procedures performed in the first few years of life.1 As a result the cardiologists and obstetricians are today facing an increasingly large group of pregnant women with surgically corrected congenital abnormalities. As these women contemplate pregnancy, they seek counseling regarding maternal and fetal outcome. The obstetrician should have adequate information about cardiac diseases during pregnancy so that he/she can function effectively as a member of the team that will be taking care of the patient. Hemodynamics are altered during pregnancy in different stages: antenatal during labor and delivery, during caesarean section and during postpartum period. Hemodynamic adaptation to pregnancy persists postpartum and gradually returns to prepregnancy values ABSTRACT Background: Although the disease is limited to only 0.5 to 1.0 percent of pregnant women, it remains an important cause of maternal morbidity and even mortality and has a significant effect on fetal outcome. Pregnancy and the peripartum period are associated with important cardiocirculatory changes that can lead to marked clinical deterioration in the woman with heart disease. Objectives of present study were to comprehend the impact of heart disease during pregnancy, to study the maternal and neonatal outcomes of pregnancies in women with heart disease, to identify predictors of pregnancy related complications in women with heart disease and to refine the risk stratification and to assess the individual risk of each pregnant woman with heart disease. Methods: It is a perspective study carried out at College Department of Obstetrics and Gynaecology, Govt. Medical, Kottayam from January 2012 to March 2014. Results:The outcomes of the pregnancies in 100 women who presented with heart disease and received their obstetrical care were evaluated. A maternal cardiac event, neonatal event, or both occurred in 37 completed pregnancies. A cardiac event complicated 8 completed pregnancies. It includes 2 maternal deaths, one on 9th postnatal day in women with hypertrophic obstructive cardiomyopathy and another in women with rheumatoid mitral stenosis who died of congestive cardiac failure. Most cardiac events (75%) occurred in the antepartum period and were either heart failure or cardiac arrhythmia. Conclusions: Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.