The management of pregnancy complicated by heart disease

Abstract

In a review of the histories of 41,361 women delivered at the Pennsylvania Hospital during the years 1937 to 1952, inclusive, the total number with heart disease was found to be 565, an incidence of 1.12 per cent.The maternal mortality rate in the pregnant cardiac patient was 2.6 per cent (15 maternal deaths). The fetal mortality rate was 12.3 per cent (70 fetal deaths). Heart disease has occupied the most prominent position as a cause of maternity mortality, accounting for 27.2 per cent of the maternal deaths from all causes during the sixteen years reviewed in our hospital.Acute congestive failure was the cause of death in 11 of the 15 deaths. Infection was the precipitating factor in 7 cases. Prematurity was the leading cause of death in the babies.The pregnant cardiac patients were divided into two groups: those delivered from 1937 to 1947, and those delivered from 1948 to 1952. The purpose was to analyze the groups in relation to the establishment of the Cardiac-Obstetric Clinic in 1948. Only one maternal death from heart disease has occurred since its inception, that of an unregistered patient.From the analysis of our patients, we believe the problems of management of pregnancy with heart disease should include the following: 1.1. An understanding of the physiological changes in the circulation in the normal pregnant woman and the changes in the pregnant woman with heart disease2.2. The diagnosis and assessment of the pregnant woman with heart disease3.3. Proper and adequate treatment during pregnancy, delivery, and pucrperiumThe different phases of treatment are diseussed in detail. Certain techniques in treatment, such as the increased use of forceps for delivery, conduction block anesthesia, and use of digitalis therapy are emphasized.Close cooperation between the cardiologist and the obstetrician at all times is strongly advocated.