Heart Disease In Pregnancy Research Articles

Ischemic Heart Disease in Pregnancy: Current Understanding and Management Strategies.

Ischemic heart disease (IHD) during pregnancy poses a rare but significant risk to maternal and fetal health, with global incidence rates ranging from 0.7 to 10 cases per 100,000 pregnancies. This review synthesizes current literature on the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and outcomes of IHD in pregnancy. Pregnancy-related IHD encompasses various conditions, including coronary artery disease, spontaneous coronary artery dissection, myocardial infarction with nonobstructive coronary arteries, coronary embolism, and coronary vasospasm. The pathophysiology is multifactorial, involving hemodynamic changes, hormonal influences, and increased hypercoagulability. Clinical presentation may mimic typical pregnancy symptoms, necessitating a high index of suspicion for timely diagnosis. A multidisciplinary strategy is needed for management, taking into account the hazards to the mother and fetus while also taking drug safety and procedural treatments such coronary artery bypass grafting and percutaneous coronary intervention into account. Careful observation and timely management are necessary for complications such as cardiogenic shock, arrhythmias, and thromboembolic events following myocardial infarction. With advancements in treatment techniques and early discovery, the prognosis has improved, although maternal mortality is still a worry. For the purpose of improving results and directing future research endeavors, knowledge and comprehension of IHD during pregnancy are essential.

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Background and aimsPre-eclampsia complicates 3–5% of pregnancies worldwide and is associated with adverse outcomes for the mother and the offspring. Pre-eclampsia and heart failure have common risk factors, including hypertension,...

High-Risk Congenital Heart Disease in Pregnancy.

High-risk congenital heart disease (CHD) in pregnancy presents a complex clinical challenge. With improved medical care and increased survival rates, a growing population of adults with complex CHD are surviving to adulthood, including women of reproductive age. This chapter focuses on risk stratification and management of pregnant women with high-risk CHD, emphasizing the importance of considering both anatomical and physiological complexity. Maternal physiological changes, such as blood volume increase, cardiac output changes, and alterations in vascular resistance, can significantly impact high-risk CHD patients. Management of high-risk CHD in pregnancy necessitates a multidisciplinary approach and individualized care.

Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series

Background: Valvular heart disease in pregnancy is still not widely studied. The combination of mitral stenosis and the physiology of pregnancy for both mother and fetus often result in poor hemodynamics, and management during labor and peripartum period greatly determines the prognosis of both lives.Case: A 42 years old G3P2A0 (Case A) and A 33 years old G3P1A1 (Case B) both had a history of previous SC labor, presented worsening shortness of breath since 2nd trimester, coughing and swelling in both legs, also unable to rest in a flat position. especially, case B was frequent re-hospitalized with prolonged LOS during 2nd – the 3rd trimester due to acute lung edema. We found a mid-diastolic murmur grade II/IV at the apex. Electrocardiography (ECG) of case A: sinus rhythm, left atrial enlargement (LAE), while case B: AF rapid response. The echocardiography of case A revealed severe MS, while case B revealed severe MS, moderate tricuspid regurgitation and, a high probability for PH. Those findings support the diagnosis of severe mitral stenosis and rheumatic heart disease in pregnancy, then they were programmed to do balloon mitral valvuloplasty (BMV) in 3rd trimester.Discussion: The BMV was performed, and succeeded in case A reducing the mitral valve pressure gradient (MV PG) from 24.7mmHg to 12.1mmHg by using local anesthesia along the procedure, while in case B specifically done BMV with general anesthesia due to supraventricular tachycardia (SVT) and pulmonal congestive during procedure, reducing the MV PG from 17.7mmHg to 8.6mmHg, as well as improvement in symptoms, up to pregnancy was terminated as obstetric indication by SC on 36-37 weeks' gestation in both cases. The baby born was healthy with weights of each case 2340gr and 2630gr. Conclusion: Mitral stenosis in the peripartum needs to be managed by interprofessional collaboration properly, to decrease the risk of morbidity and mortality for the mother and fetus.

Cardiovascular disease in pregnancy and its outcome: A prospective study.

Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases.

Pregnancy with heart disease: Fetomaternal outcome: A retrospective analysis from a tertiary care teaching hospital in Northern India

Background: Heart diseases are the most significant non-obstetrical causes of maternal deaths, accounting for up to 15% of all cases. The present retrospective analysis is an attempt to assess the spectrum and impact of cardiac diseases on pregnancy. Aims and Objectives: The aims of this study were to analyze the maternal and perinatal outcomes and spectrum of heart disease in pregnancy. Materials and Methods: The study was carried out in the Department of Obstetrics and Gynecology at PGIMS, Rohtak, where retrospective record of inpatient obstetrics registry of pregnant women with cardiac diseases was analyzed. Clinical information obtained from the patient’s medical records including clinical presentation, laboratory investigations, 2-D echocardiography, maternal, and neonatal outcomes were noted. All pregnant women as well as postpartum patient with cardiac disease were included in the study. Results: A total of 62 pregnant women with heart diseases were hospitalized during the study period. Spectrum of heart disease among these women analyzed and we found that the 22 had rheumatic heart disease (RHD), 14 had congenital heart disease (CHD), and 14 had cardiomyopathies (CMP). LSCS was done for 24 and out of these, nine were elective LSCS while 15 were emergency LSCS. Vaginal deliveries were performed in 31 women. Twenty-eight women got shifted to intensive care units during course of treatment. Three intrauterine deaths were noted in our study. Conclusion: We have concluded from the present study and after reviewing the literature about spectrum of heart diseases in pregnancy, that the most common cardiac lesions complicating the pregnancy are RHD followed by CHD and CMP. Successful management of heart disease with pregnancy can be achieved by timely diagnosis and safe transfer of patient to the cardiomaternal tertiary care, where multidisciplinary teams are available.

Heart diseases in pregnancy in Northern Nigeria – A brief review

Abstract Physiological changes of pregnancy exert stress on the heart that could lead to cardiac decompensation, especially in the presence of background diseases such as cardiomyopathy, hypertension, valvular, or congenital heart diseases. Heart disease in pregnancy is an important contributor to maternal and fetal adverse outcomes. Although data on heart disease in pregnancy are generally scarce, a few available studies have shown higher prevalence in northern than southern regions of Nigeria. In addition, clinical outcomes among pregnant women diagnosed with heart disease are worse than among those without and apparently healthy women. The aim of this review was to describe the pattern and outcomes of heart disease in pregnancy in Northern Nigeria and to identify the existing gaps in knowledge, which can be explored in a subsequent multicenter national study.

Focused cardiac ultrasound in pregnancy.

Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.

Cyanotic Congenital Heart Disease in Pregnancy: A Review of Pathophysiology and Management.

The advancement of medical treatment and surgical technique, along with the invention of cardiopulmonary bypass, has allowed for long-term survival of patients with cyanotic congenital heart disease (CHD)-with many women with CHD now reaching child-bearing age and wishing to become pregnant. Pregnancy in these women is a major concern as the physiologic adaptations of pregnancy, including an increased circulating volume, increased cardiac output, reduced systemic vascular resistance, and decreased blood pressure, place a substantial load on the cardiovascular system. These changes are essential to meet the increased maternal and fetal metabolic demands and allow for sufficient placental circulation during gestation. However, in women with underlying structural heart conditions, they place an additional hemodynamic burden on the maternal body. Overall, with appropriate risk stratification, pre-conception counseling, and management by specialized cardiologists and high-risk obstetricians, most women with surgically corrected CHDs are expected to carry healthy pregnancies to term with optimization of both maternal and fetal risks. In this article, we describe the current understanding of 5 cyanotic CHDs-Tetralogy of Fallot, Transposition of the Great Arteries, Truncus Arteriosus, Ebstein's Anomaly, and Eisenmenger Syndrome-and explore the specific hemodynamic consequences, maternal and fetal risks, current guidelines, and outcomes of pregnancy in women with these conditions.

Editorial

Editorial

History of offspring congenital heart disease in pregnancy increases risk of preeclampsia in subsequent pregnancy

History of offspring congenital heart disease in pregnancy increases risk of preeclampsia in subsequent pregnancy

Pregnancy related acute myocardial infarction: Current trends in treatment and future prospects

Acute myocardial infarction in pregnant women is an uncommon but potentially devastating complication with significantly increased rates of maternal and perinatal morbidity and mortality. The treatment of acute coronary syndrome in pregnancy is a unique clinical challenge. Published data on the use of thrombolytic drugs, percutaneous coronary intervention, coronary artery bypass grafting and optimal medical management of ischemic heart disease in pregnancy are limited. This article attempts to review acute myocardial infarction in pregnancy, regarding the basic treatment principles, the timely and correct application of which can yield the best possible result for the mother and the fetus and the newborn.

Anesthesia Management in Pregnancy with Heart Disorder using Walking Epidural Analgesia (WELA)

<p><strong>Background</strong>: Heart disease in pregnancy is one of the leading causes of morbidity and mortality in pregnancy and childbirth. The intrapartum and postpartum periods are critical periods in which most of the deaths occur in this period. Manifestations appear in the form of heart failure which increases maternal and fetal morbidity and mortality.</p><p><strong>Case Illustration</strong>: We will report a case report of a 23-year-old woman with a diagnosis of G2P0A1 H 40 weeks, a single live intrauterine fetus with congestive heart failure due to rheumatic heart disease with mitral stenosis.</p><p><strong>Conclusion</strong>: The patient successfully underwent spontaneous labor under anesthesia facilitated by the walking epidural analgesia (WELA) technique with levobupivacaine and fentanyl agents which were administered continuously using a syringe pump during the labor process.</p>

A Retrospective Study to Evaluate the Maternal and Fetal Outcome in Patients of Heart Disease in Pregnancy at a Tertiary Rural Hospital

Background: Heart disease(HD) in pregnancy remains an important cause of maternal, fetal morbidity and mortality especially in a developing country like India, where incidence of cardiac disease that complicates pregnancy is between 1% to 4% & Rheumatic heart disease (RHD) still remains the most common type of heart disease complicating pregnancy due to Poor socioeconomic condition. Methods: This is a retrospective observational study carried out in Department of Obstetrics and Gynaecology at S.M.B.T. Institute of medical sciences, Dhamangaon during the period of 24 months to assess the maternal and fetal outcome on patients of heart disease with pregnancy. Result: Among the 3182 patients delivered in the study 35 had cardiac disease with prevalence of 1.1%, all patients were booked and diagnosed with heart disease during ANC checkup. Rheumatic Heart disease (70%) was the commonest form of heart disease with MS with MR predominating (22%). NYHA grade 2 patients (41%) were maximum with Anemia as the associated complicating factor.4 patients with severe MS required balloon mitral valvotomy (BMV) of them 1 patient went into pulmonary edema. There was no maternal mortality. 2 patients underwent medical termination of pregnancy (MTP) for cardiac reason and there was 1 neonatal mortality. Conclusion: RHD is still the commonest heart disease in pregnancy; BMV can be performed in third trimester on patients with severe MS reducing intra and postpartum complications. Giving good and timely antenatal, Intranatal and postnatal care at a tertiary care hospital with good cardiac, obstetric & Neonatal care setup reduces maternal and fetal morbidity in patients of heart disease with pregnancy. Keywords: Rheumatic heart disease in pregnancy, Congenital heart disease in pregnancy, Balloon Mitral Valvotomy in pregnancy

Study on impact of Rheumatic Heart Disease in Pregnancy

Study on impact of Rheumatic Heart Disease in Pregnancy

CARDIAC DISEASE IN PREGNANCY AND MATERNAL OUTCOME - A RETROSPECTIVE STUDY

Objectives : To evaluate the maternal outcomein patients with cardiac disease in pregnancy in terms of maternal complication and mode of delivery. Materials And Methods : Medical records of 50 women with heart disease who delivered at >/= 28 weeks of gestation from March 2018 to February 2022 at Department of Obstetrics and Gynecology ,Basaweshwara Hospital ,attached to MahadevappaRampure Medical college ,Kalaburgi , were studied . Results : The prevalence of heart disease in pregnancy was 1%.There were 6(12%) with congenital heart disease(CHD) and 36(72%) with rheumatic heart disease(RHD), other lesions were 8(16%).76% of the women from rural background , 24% of the women from urban background .Isolated Mitral Regurgitation(MR) was the most common defect in rheumatic heart disease , atrial septal defect is the most common congenital lesion seen.64% of women remained NYHA class I throughout pregnancy. Heart failure developed in 2 patients whose NYHA changed from I/II to III /IV .18 women underwent corrective procedures prior or during pregnancy had good outcome. The maternal mortality was 2%.The incidence of preterm labor was 8%. Majority of the women delivered by spontaneous vaginal delivery 18(36%) while 16(32%) had caesarean section ,14(28%) had instrumental vaginal delivery , 2(4%) had vaginal delivery after induction . Conclusion: Cardiac disease is an important cause of maternal morbidity and mortality. Patients with NYHA class I/II had a better maternal outcome than those with NYHA class III/IV. Surgical correction of the cardiac lesion prior to pregnancy was associated with better pregnancy outcome.

Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training.

Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.

Obstetric outcome in patients with rheumatic heart disease: experience in a tertiary hospital

Aims: To determine the clinical outcome of rheumatic heart disease in pregnancy.
 Methods: Retrospective cross-sectional descriptive study from April 2019 to April 2021 in Nobel Medical College, Biratnagar, Nepal. Feto-maternal variables were taken for their health status. Data presented in table with frequency.
 Results: Out of 13013 deliveries in a year, 49 had cardiac disease (0.37%) and 38 had rheumatic heart disease (0.29%) over 28 weeks of gestation; 95% (n=36) had mitral valve involvement; 12 were primigravida and 7 preterm at the time of delivery. Half of them underwent caesarean section for various indications. Most common maternal complications were cardiac failure, cardiac arrythmia, admission to ICU, obstetric complications, including maternal mortality in 5.2% (n=2) cases. Low birth was in 29% (n=11) of cases, and 34% (n=13) of them needed NICU care at the time of delivery. There was history of rheumatic fever in 9 cases (24%).
 Conclusions: Rheumatic heart disease is the commonest diagnosis among heart disease in pregnancy and adverse event can be minimized by multidisciplinary intervention

Maternal mortality and predictors of adverse outcome in patients with heart disease in pregnancy.

Heart disease in pregnancy possesses a great haemodynamic challenge and is a known risk for increased maternal morbidity and mortality. The functional status of the patient is one of the most significant parameters which can impact the feto-maternal outcome. Many predictors have been studied and compiled in various scoring systems time and again. The most updated and validated is the modified WHO classification, according to which the presence of pulmonary artery hypertension (PAH) and severe ventricular dysfunction (ejection fraction <30%) mandates the patient to be under class IV, which along with another important risk factor, i.e., New York heart association (NYHA) class, is revaluated under the present study. The objective of this study is to examine three of the most important predictors of adverse outcomes, i.e., functional status (NYHA class), PAH, and left ventricular ejection fraction (LVEF) in patients with heart disease in pregnancy. It's a prospective study from January 2016 to August 2017 wherein pregnant patients with heart disease were divided on the basis of NYHA class, PAH, and LVEF, and the feto-maternal outcome was recorded and evaluated in terms of maternal mortality, fetal demise, the occurrence of major cardiac complication, and risk of preterm delivery. A total of three out of 29 (10.34%) maternal deaths were attributed to a cardiac cause. 5.45% of patients with heart disease had maternal mortality, which is in contrast to the 1.12% maternal mortality rate in general at our centre. Three out of 17 (17.64%) patients in NYHA classes 3 and 4 ended in maternal deaths, while there were no mortalities in classes 1 and 2. Intrauterine fetal demise (23.52%), risk of preterm delivery (relative risk = 0.4688; 95% CI: 0.2320 to 0.9470) was significantly higher in patients belonging to NYHA classes 3 and 4 as compared to those in classes 1 and 2. All of the ten (100%) patients who developed cardiac complications belonged to classes 3 and 4. The percentage of abortions (20.00%), intra uterine fetal demise (IUFD) (40.00%), and cardiac complication (80%) in patients with LVEF <44% were significantly more than in patients with better ejection fraction. Pulmonary artery systolic pressure (PASP) ≥ is associated with higher maternal mortality, a greater number of abortions and IUFD (22.62%), cardiac complication (22.72%), and increased risk of preterm birth (0.5769; 95% CI: 0.2801 to 1.188), but these associations are not found to be significant. NYHA class was found to be a very strong predictor followed by left ventricular ejection fraction for poor outcome. Maternal mortality in asymptomatic patients or patients with mild symptoms (NYHA classes 1 and 2) is comparable to that found in the general population. However, pulmonary artery systolic pressure is not found to be significantly associated with worse outcomes in our study.

Maternal and Perinatal Outcomes of Pregnant Women with Heart Disease in Three Yaound&amp;#233; Referral Hospitals

Heart disease in pregnancy is the cause of significant maternal and perinatal morbidity. We wanted to evaluate the maternal and perinatal outcomes of pregnant women with heart disease in Yaoundé, Cameroon. This was a cross sectional study with retrospective data collection of 45 pregnancies in 42 women with heart disease followed at three Yaoundé referral hospitals in Yaoundé, Cameroon from January 1st 2015 to December 31st 2020. We collected data on maternal obstetrical and perinatal outcomes. The frequency of pregnancies with heart diseases was 0.1%. The mean maternal age was 29.05 ± 6.5 years. At first antenatal visit, all patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class. Valvular heart disease (51.1%) was the most common type followed by cardiomyopathy (37.7%). Over half of the deliveries were vaginal (51.1%). A cesarean section was generally indicated for the usual obstetrical reasons (54.5%) and for heart disease (31.8%). Complications included 17 (37.7%) cases of heart failure, 6 (13.3%) cases of pulmonary edema, 2 (04.4%) cases of pulmonary embolism, 3 (06.6%) maternal deaths and 3 (06.3%) perinatal deaths, 14 (29.7%) premature births and 3 cases of (6.3%) intrauterine growth retardation. The maternal deaths were cases complicated by pulmonary edema and all had dilated cardiomyopathy. The maternal and perinatal outcomes of pregnant women with heart disease are marked in our environment by increased morbidity and mortality. Therefore, it is necessary to improve the prenatal, per partum and postpartum management of this high-risk group.