Abstract
BackgroundSevere valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease.MethodsThis is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017.ResultsWe included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12–5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26–31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14–41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01–1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15–23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19–23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002–1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98–38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2–84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4–36.1]).ConclusionsRevelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial.
Highlights
IntroductionEspecially stenosis, is a contraindication for conception according to the World Health Organization
Severe valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization
These complications were associated with nulliparity, multiple valve disease, systolic pulmonary arterial pressure, and treatment with vitamin K antagonists
Summary
Especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. Hammami et al BMC Pregnancy and Childbirth (2021) 21:813 are rheumatic valvular pathology in low- and middleincome, and congenital heart diseases in high-income countries [3, 4]. The World Health Organization (WHO) considers severe stenotic valvular heart diseases as a contraindication for conception (WHO IV category) [5]. Because rheumatic heart disease is still prevalent in Tunisia [6], managing pregnant women with such conditions is a daily challenge for obstetricians, cardiologists, and anesthesiologists. Clinicians have to deal with two main challenges: 1. should they opt for termination of pregnancy due to the huge maternal and fetal risks? 2. what is the most appropriate mode of birth in case of continuation of pregnancy?
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