Feto-maternal complications and outcomes of pregnant women with valvular heart disease in a tertiary center in Ethiopia

ObjectiveTo assess the incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease (RHD) and to derive a clinical risk scoring for predicting it.MethodsThis is an observational study involving pregnant women with RHD, attending a tertiary centre in south India. Data regarding obstetric history, medical history, maternal complications and perinatal outcome till discharge were collected. Eight-hundred and twenty pregnancies among 681 women were included in the analysis. Primary outcome was composite adverse cardiac event defined as occurrence of one or more of complications such as death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism and new-onset arrhythmias.ResultsOf the 681 women with RHD, 180 (26.3%) were diagnosed during pregnancy. Composite adverse cardiac outcome during pregnancy/post partum occurred in 122 (14.9%) pregnancies, with 12 of them succumbed to the disease. In multivariate analysis, prior adverse cardiac events (OR=8.35, 95% CI 3.54 to 19.71), cardiac medications at booking (OR=0.53, 95% CI 0.32 to 0.86), mitral stenosis (mild OR=2.48, 95% CI 1.08 to 5.69; moderate OR=2.23, 95% CI 1.19 to 4.18; severe OR=7.72,95% 4.05 to 12.89), valve replacement (OR=2.53, 95% CI 1.28 to 5.02) and pulmonary hypertension (OR=6.90, 3.81 to 12.46) were predictive of composite adverse cardiac events with a good discrimination (area under the curve=0.803) and acceptable calibration. A predictive score combining these factors is proposed for clinical utility.ConclusionHeart failure remains the most common adverse cardiac event during pregnancy or puerperium. Combining the lesion-specific characteristics and clinical information into a predictive score, which is simple and effective, could be used in routine clinical practice.

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Valvular heart disease in pregnant women of Morocco: Complications, predictive factors and prognosis

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2017.11.292 ◽

2018 ◽

Vol 10 (1) ◽

pp. 77-78

Author(s):

S. Ballali ◽

K. Belkadi ◽

I. Moussaid ◽

A. Assaidi ◽

R. Habbal ◽

...

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Predictive Factors ◽

Valvular Heart Disease

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FETOMATERNAL OUTCOME IN PREGNANCY WITH CARDIAC DISEASE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2007 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Kalyani K Bafna ◽

Kanaklata Nakum ◽

Aditi Vithal

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Maternal Morbidity ◽

Nyha Class ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Maternal Complications ◽

Maternal Morbidity And Mortality

Objective(S): Cardiac disease is an important cause of maternal morbidity and mortality in both antepartum as well as in postpartum period. Incidence of heart disease with pregnancy is <1%. Aim of this study is to determine maternal complications with heart disease, mode of delivery & fetal complications. Materials & Methodology: This is a retrospective study conducted at Gopinath Maternity Home, Sir-T Hospital, Bhavnagar. From May 2020- April 2021. All pregnant women with various cardiac disease (previously established or diagnosed during pregnancy) who came to labor room or OPD are included. Result: 30 pregnant women out of 2683 deliveries were identified with cardiac disease giving prevalence of 1.12% in this study. 15(50%) women belonging to NYHA class-1 & 8(26.6%) belonged to NYHA class 2. Class 3(3 patients =10%) & class 4(4patients= 13.3%) were admitted immediately. 18(60%) women were case of valvular heart disease, out of which 12(66.6%) cases were of RHD, 2(11.1%) were MS, 3(16.6%) AS, 1(5.5%) MR. 10(33.33%) cases were congenital heart disease. Maternal mortality were 4(13.33%). Out of 30 cases, 18(69.2%) women had LSCS, 6(23.07%) had vaginal delivery,2(7.7%) had vaccum & 3(10.3%) had abortion. Out of 26 deliveries 2(7.7%) were IUFD, 6(23.07%) Preterm, 7(26.9%) IUGR. Total there were 9(37.5%) NICU admissions. Conclusion: Prognosis of pregnancy with heart disease has improved but management of it is still a challenge for obstetricians. Pre-conceptional counseling plays an important role by benefiting women with severe heart disease and thus help in reducing maternal morbidity and mortality. Keywords: cardiac disease, maternal outcome, fetal outcome

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Echocardiographic Evaluation of Hemodynamic Changes in Left-Sided Heart Valves in Pregnant Women With Valvular Heart Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2016.07.005 ◽

2016 ◽

Vol 118 (7) ◽

pp. 1046-1052 ◽

Cited By ~ 11

Author(s):

Niloufar Samiei ◽

Mandana Amirsardari ◽

Yousef Rezaei ◽

Mozhgan Parsaee ◽

Fahimeh Kashfi ◽

...

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Valvular Heart Disease ◽

Heart Valves ◽

Hemodynamic Changes ◽

Echocardiographic Evaluation

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What Is the Optimal Management of Pregnant Women with Valvular Heart Disease in Pregnancy?

Pathophysiology of Haemostasis and Thrombosis ◽

10.1159/000054124 ◽

1999 ◽

Vol 29 (1) ◽

pp. 105-106 ◽

Cited By ~ 3

Author(s):

Wee Shian Chan

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Valvular Heart Disease ◽

Optimal Management ◽

Heart Disease In Pregnancy ◽

In Pregnancy

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Structural Heart Diseases during Pregnancy: Part 1—Valvular Heart Diseases

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1676549 ◽

2018 ◽

Vol 03 (02/03) ◽

pp. 108-114

Author(s):

Amar Patnaik

Keyword(s):

Heart Disease ◽

Pregnant Woman ◽

Pregnant Women ◽

Valvular Heart Disease ◽

Heart Diseases ◽

Medical Science ◽

Morbidity And Mortality ◽

Team Approach ◽

Echocardiographic Evaluation ◽

Valvular Heart Diseases

AbstractIt is estimated that about 3% pregnancies can have cardiac disease. There is wide variation in the spectrum of heart diseases. Pregnant women in India and other developing countries continue to show high prevalence of rheumatic heart disease (RHD). Pre-conception counseling based on a good echocardiographic evaluation is the most cost-effective method to prevent morbidity and mortality due to valvular heart disease. With advances in medical science, many with valvular heart disease are living to adulthood and undergoing successful pregnancy. Symptoms of a pregnant woman with a valvular disease depend on the altered hemodynamics of the specific valvular lesion in combination with the physiologic changes inherent to the pregnancy itself. A good echocardiographic evaluation of all pregnant women on their first visit to an obstetrician’s office is an effective strategy to prevent morbidity and mortality from valvular heart diseases. In general, the regurgitant lesions are well tolerated during pregnancy and labor. Asymptomatic but significant valve lesions can be decompensated by many factors. Severely stenosed mitral and, sometimes, aortic valve may have to be balloon-dilated by trained experts in midterm taking due care to avoid excess radiation. Valve surgery is rarely performed in absence of any other safer option. A multidisciplinary team approach is required to manage a pregnant woman with significant cardiac lesion with high-risk features and patients having mechanical valves that require continuous anticoagulation.

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