scholarly journals Maternal and perinatal outcome in heart disease complicating pregnancy

2021 ◽  
Vol 10 (10) ◽  
pp. 3725
Author(s):  
Tanvi Kumar ◽  
Rishman Tandi ◽  
Amritaa Thalla
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Perinatal Outcome ◽  
Heart Diseases ◽  
Nyha Class ◽  
Morbidity And Mortality ◽  
Elective Cesarean Section ◽  
Perinatal Morbidity

Background: Congenital as well as acquired heart diseases remain one of the important factors complicating pregnancy and remains a significant cause of maternal as well as perinatal morbidity and mortality. Pregnant women with cardiac diseases need a comprehensive management strategy to minimize the adverse effect of cardiac conditions on pregnancy and its outcome.Methods: This was an observational study conducted in a tertiary care hospital located in an urban area. Pregnant patients diagnosed to be having congenital or acquired heart diseases and admitted either in ward, labour room or intensive care unit were included in this study on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all the cases. Patients were classified according to New York Heart Association. Maternal and perinatal Outcome was studied in cases.Results: The incidence of cardiac disease amongst pregnant patients during study period was found to be 0.58%. The mean age of studied cases was found to be 23.16±5.06 years. Most of the patients were primigravida (85.71%) and 6 patients (14.29%) were multigravida. The majority of the patients (76.19%) belonged to NYHA grade I whereas 8 (19.05%) patients belonged to NYHA class II. 1 patient belonged to NYHA Class III and Class IV respectively. Isolated mitral stenosis secondary to rheumatic valvular involvement was the single most common lesion seen in studied cases and was seen in 8 (19.05%) patients. Ventricular septal defect was most common congenital heart disease (14.28%). 26 (61.90 %) delivered by normal vaginal delivery whereas emergency and elective LSCS was done in 9 (21.43%) and 6 (14.29%) patients respectively. nature of cardiac disease was common factor for elective cesarean section which was done in 5 cases (11.90%). Postpartum cardiac failure (14.29%) and postpartum hemorrhage (9.52%) were common maternal complications. 24 (57.14%) neonates required admission in neonatal intensive care unit. The most common indication for NICU admission was found to be low birth weight (23.81%) followed by birth asphyxia (19.05%).Conclusions: Cardiac disease in pregnancy is associated with increased risk of maternal as well as perinatal morbidity and mortality. Early diagnosis and management during pregnancy is essential to reduce maternal as well as perinatal outcome in these cases.

scholarly journals Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at tertiary level hospital of Uttarakhand

2017 ◽  
Vol 6 (8) ◽  
pp. 3338
Author(s):  
Priyanka Chaudhari ◽  
Vineeta Gupta ◽  
Nidhi Kumari ◽  
Archna Tandon ◽  
Nimisha Gupta
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Heart Diseases ◽  
Nyha Class ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Cardiac Diseases ◽  
Class Iii ◽  
Maternal Deaths ◽  
Common Cause

Background: Cardiac disease is the most common cause of indirect maternal deaths and most common cause of death overall. It complicates 1% of all maternal deaths. The maternal and neonatal risks associated with pregnancy in women with cardiac disease receiving comprehensive prenatal care have not been well defined. Objective of present study was to evaluate the burden of cardiac diseases in pregnancy in our hospital, their clinical presentation, type of cardiac lesion, associated complications, maternal and fetal outcome.Methods: A retrospective study was conducted in Obstetrics and gynecology department at Shri Guru Ram Rai Institute of medical and health sciences, Dehradun from January- 2013 to December-2015. All patients with cardiac diseases during pregnancy or developed during postpartum period were included in the study. Detailed Demographic profile of patients, mode of delivery, perinatal outcome, associated antenatal, intranatal and postnatal complications were analyzed in detail.Results: There were 37 patients with cardiac disease during pregnancy in our study period. Out of these 32.4% were diagnosed during current pregnancy. Rheumatic heart diseases were seen in 54.05% patients and congenital heart disease seen in 35.1%. out of these 81.1% patients belonged to NYHA class I and II and 18.9% patients in class III & IV. Majority of patients (78.3%) had vaginal delivery. We observed 5.4% maternal mortality and 2.7% of neonatal mortality rate.Conclusions: Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications. Multidisciplinary approach involving cardiologist, obstetrician and neonatologist improves fetomaternal outcome.

Establishing Cardiac Surgery in Eastern Nepal: Early Results

2018 ◽  
Vol 16 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Lokesh Shekher Jaiswal ◽  
Jagat Narayan Prasad ◽  
Prashant Shah ◽  
Narendra Pandit
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Nyha Class ◽  
Open Heart Surgery ◽  
Left Atrial Myxoma ◽  
Early Results ◽  
The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years). The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.

scholarly journals FETOMATERNAL OUTCOME IN PREGNANCY WITH CARDIAC DISEASE

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

scholarly journals Maternal and fetal outcome in pregnancy with heart disease in tertiary care hospital in India

2017 ◽  
Vol 6 (9) ◽  
pp. 3947 ◽  
Author(s):  
Samia Salam ◽  
Saba Mushtaq ◽  
Khalid Mohi-ud-Din ◽  
Irfan Gul ◽  
Asifa Ali
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Nyha Class ◽  
Tertiary Care ◽  
Normal Vaginal Delivery ◽  
Care Hospital ◽  
In Pregnancy

Background: Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. Objective of present study was to determine maternal outcome in pregnant women with heart diseases in terms of fetal complication, maternal complication and Mode of delivery.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Government Lalla Ded Hospital, an associated of Government Medical College, Srinagar which is the sole tertiary care referral centre in the valley. 90 women with heart disease which were previously established   or diagnosed during pregnancy were enrolled in the study.Results: In 90 women pregnancies was complicated by heart disease in the study. The prevalence of heart disease amongst all pregnancies found in hospital was 4.3%. The principal cause of cardiac lesion was Rheumatic heart disease (RHD) (56.6%) while congenital heart disease was seen in 13.3%. Among the women who had RHD, mitral stenosis seen in 21 (23.3%) was most common lesion and Multiple cardiac lesions 21 (24.4%) women. Among the women with congenital cardiac disease, mitral valve prolapse was most common constituting 5 (5%) cases. Cardiomyopathy was the most common constituting 7 (7.3%). Heart failure developed in 10 (11.1%) whose NYHA class changed from class I/II to class III/IV. Majority of the women delivered by caesarean section 33 (36.7%) while (35.6%) had a normal vaginal delivery with spontaneous onset of labour. 7% had assisted instrumental vaginal delivered.  9% women had first trimester abortion. There were 4 maternal deaths. 85.6% live births were observed in these women. No baby had congenital heart disease.  72.8% babies born weighed more than 2kg.Conclusions: This study concluded that pre- pregnancy diagnosis, counselling, appropriate referral, antenatal supervision and delivery at equipped centre improve the pregnancy with heart disease outcome for both mother and baby.

scholarly journals Establishing Pediatric Cardiac Intensive Care Unit in a Low Resource Setting: Bangladesh Perspective and Dhaka Shishu (Children) Hospital Paediatric Cardiac Intensive Care Unit Model

2017 ◽  
Vol 39 (3) ◽  
pp. 141-147 ◽  
Author(s):  
Manzoor Hussain ◽  
Mohammad Abdullah Al Mamun ◽  
Nurul Akhtar Hasan ◽  
Rezoana Rima ◽  
Abdul Jabbar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Critically Ill Children ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care

Advances in technology and training in paediatric cardiology have improved longterm outcome and promised better quality of life. Bangladesh is facing multitude of health problems and congenital heart disease is one of them. With facilities for accurate diagnosis and scope of complete correction, more and more children are undergoing cardiac intervention and surgical treatment for congenital heart diseases. So there is increasing demand for dedicated personnel for the specialized intensive care of these critically ill children. A dedicated team dictating specialized intensive care has translated into better outcomes in several centers. Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill neonatal and paediatric patients with congenital and acquired heart disease worldwide. The majority of developed centers have dedicated paediatric cardiac intensive care units to care for paediatric cardiac patients. In developing countries with limited resources, pediatric cardiac intensive care is yet to take root as a distinctive discipline. Congenital heart surgery, together with transcatheter interventions, has resulted in marked improvement in cardiac care in Bangladesh. So, we need to establish more and more dedicated paediatric cardiac center and cardiac intensive care units to care for paediatric cardiac patients.Bangladesh J Child Health 2015; VOL 39 (3) :141-147

scholarly journals Cardiovascular disease in pregnancy

2019 ◽  
Vol 8 (9) ◽  
pp. 3789
Author(s):  
Rupa Vyas ◽  
Priya Gupta ◽  
Sapana Shah ◽  
Komal Rangoliya
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Multidisciplinary Approach ◽  
Heart Diseases ◽  
Care Center ◽  
Nyha Class ◽  
Tertiary Care ◽  
Close Monitoring ◽  
Age Group ◽  
In Pregnancy

Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups.

scholarly journals Establishing Cardiac Surgery in Eastern Nepal: Early Results

2018 ◽  
Vol 16 (3) ◽  
pp. 257-263
Author(s):  
Lokesh Shekher Jaiswal ◽  
Jagat Narayan Prasad ◽  
Prashant Shah ◽  
Narendra Pandit
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Open Heart Surgery ◽  
Left Atrial Myxoma ◽  
Early Results ◽  
The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years).The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.Keywords: CABG; cardiac surgery; congenital heart disease; early results; RHD.

scholarly journals Perinatal Outcome of the Second Twin

2015 ◽  
Vol 10 (1) ◽  
pp. 89-93
Author(s):  
R Joshi ◽  
G Baral
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins. 

scholarly journals Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

2014 ◽  
Vol 35 (10) ◽  
pp. 1304-1306 ◽  
Author(s):  
David J. Weber ◽  
David van Duin ◽  
Lauren M. DiBiase ◽  
Charles Scott Hultman ◽  
Samuel W. Jones ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
The United States ◽  
Burn Injuries ◽  
Morbidity And Mortality ◽  
Common Source ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

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