Abstract
Background and Aims: Pregnancy in patients with rheumatic heart disease has always been challenging. Haemodynamic changes in pregnancy with diseased heart may cause adverse maternal and fetal outcome.Methods: A prospective study was done in pregnant women with rheumatic heart disease over a period of 2 years from 2015 to 2016 at Tribhuwan University Teaching Hospital, Kathmandu. Baseline data collected at antenatal period were analyzed with obstetric outcomes.Results: A total of 85 women were enrolled in this study. Sixty percent of the women were primigravida. Mitral stenosis was the commonest lesion (69.41%), followed by mitral regurgitation (25.88%) and aortic stenosis (4.71%). Cardiac events were noted in 32 patients out of which 11 developed pulmonary oedema and 6 had new onset of atrial fibrillation. Vaginal delivery (58.82%) was the commonest mode of delivery followed by cesarean section (24.7%). Eighty percent of women remained in NYHA functional class I and II, whereas 20% had deterioration of functional class. There were more maternal and fetal complications in women with NYHA III or IV in comparison to women with NYHA I or II. Low birth weight infants were found in 37.64% of cases. There was one maternal death in a lady with severe mitral stenosis with moderate mitral regurgitation due to congestive heart failure at 34 weeks of gestation. There were 8 fetal and 11 neonatal deathConclusions: Functional cardiac status during pregnancy has a major impact on maternal and fetal outcome. Rheumatic heart disease diagnosed before pregnancy may improve the outcome.Nepalese Heart Journal 2017; 14(2): 31-34
Highlights
Heart disease complicates 1% of all pregnancies[1,2]
The hemodynamic changes of pregnancy can have a negative impact on maternal health, especially in women with preexisting cardiac disease as the diseased heart may not be able to adjust with extra load resulting in heart failure and even in mortality
Majority of women remained in NYHA class I or II throughout the pregnancy (Chart I)
Summary
Heart disease complicates 1% of all pregnancies[1,2]. Cardiac abnormalities are considered the leading non-obstetric cause of maternal morbidity and mortality[3]. Though rare in developed country, rheumatic heart disease is still predominant in developing countries and continues to be a major cause of maternal morbidity and mortality[1,4,5]. The hemodynamic changes of pregnancy can have a negative impact on maternal health, especially in women with preexisting cardiac disease as the diseased heart may not be able to adjust with extra load resulting in heart failure and even in mortality. Women with rheumatic heart disease, especially significant mitral stenosis tolerate pregnancy poorly[6]. Haemodynamic changes in pregnancy with diseased heart may cause adverse maternal and fetal outcome. There was one maternal death in a lady with severe mitral stenosis with moderate mitral regurgitation due to congestive heart failure at 34 weeks of gestation. Rheumatic heart disease diagnosed before pregnancy may improve the outcome
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