The prognosis of heart disease in pregnancy

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There appears to be a considerable difference in the published statistics of the mortality of cardiac patients who are pregnant.Cardiac disease is stated to have accounted for nearly 20 per cent of the total maternal mortality during a four-year period at the Boston Lying-In Hospital and for 28 per cent of the deaths during a period of seven years at the Faulkner Hospital.In Table I are given some interesting statistics already published by Hamilton and Kellogg.1The deaths from cardiac disease were but 4 per cent of the mortality from all causes at the Robinson Memorial for a period of twelve years (1916 to 1927); for the entire state of Massachusetts organic disease of the heart accounted for 6 to 7 per cent of the mortality in parturition.Analysis of 830 cardiac patients who were pregnant reported in the literature discloses a mortality of 5.1 per cent. The cardiac deaths comprised 8.1 per cent of the deaths from all causes during pregnancy and parturition.Statistics from the Boston Lying-In Hospital, New York Lying-In Hospital, and the Robinson Memorial when combined show 45,320 deliveries, 480 deaths from all causes, and 48 deaths from cardiac disease. The cardiac mortality amounts to 10 per cent of the deaths from all causes. This indicates that about one mother died for each 100 deliveries, and that but one in 1000 parturients died from organic disease of the heart.The difference in various published statistics is discussed and it is suggested that the method of classifying the patients is of significance. The majority of recent observers classify their cardiac patients according to the degree of insufficiency of the heart rather than according to the structural lesions diagnosed.Prognosis is affected by the care given and the skill used in the treatment of the individual patient.