Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at a tertiary level hospital

Heart disease in pregnancy is one of the leading non-obstetric causes of maternal mortality and is the leading cause of maternal intensive care unit admissions in the world. To study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management. The presence of comorbidities and the occurrence of obstetric, fetal, and cardiovascular complications during delivery among women with heart disease hospitalized for delivery were studied in 35 women at GSL Medical College, Rajahmundry for a period of 1 year from 01/01/2019 to 1/1/2020: Over a period of 12 months, 35 subjects were recruited. During this period, there were 5005 deliveries. The majority of women were aged between 20-25yrs and were unbooked cases belonging to NYHA class I or II. Cesarean section and operative vaginal delivery were more common. Despite the multidisciplinary approach, 3 women succumbed to the disease of which one was a case of severe rheumatic heart disease with valve failure, the second was a case of postpartum cardiomyopathy and the third was a case of severe pulmonary arterial hypertension. Fetal outcome in cardiac patients is usually good and only a little different from those patients who do not suffer from heart disease. Pregnant women with heart disease were more likely to experience adverse events during delivery. These women require a multidisciplinary team for optimal maternal and foetal outcomes.

Use of venous-venous extracorporeal membrane oxygenation in the treatment of postpartum pulmonary hypertension crisis

The incidence of heart disease in pregnancy ranges from 0.5% to 3.0% and is regarded as one of the top three causes of maternal death. The mortality rate of patients with pulmonary hypertension and Eisenmenger syndrome is as high as 16.7%–50%. Changes in haemodynamics during pregnancy and childbirth increase the burden on the heart, and induced pulmonary hypertension crisis is one of the main causes of maternal death. Extracorporeal Membrane Oxygenation (ECMO) is the last-resort treatment strategy to treat patients with pulmonary hypertension crisis. We report a ventricular septal defect in a pregnant woman with pulmonary hypertension and Eisenmenger’s syndrome, which is a postpartum pulmonary hypertension crisis that leads to respiratory and circulatory disorders. The patient was successfully treated with venous-venous extracorporeal membrane oxygenation.

A RETROSPECTIVE STUDY ON CARDIAC DISEASE IN PREGNANCY

Cardiac disease in pregnancy is one of the common ,indirect obstetric causes of maternal mortality reported incidence varying between 0.5 and 5.9% worldwide. The rise in maternal mortality has been attributed to increasing numbers of women at advanced maternal age undertaking pregnancy, comorbid pre-existing conditions such as diabetes mellitus and hypertension and the growing number of women with congenital heart disease surviving to childbearing. Valvular heart disease is present in 80% of patients with heart disease during pregnancy in developing countries with rheumatic fever as the most common etiology and the mitral valve being the most commonly affected valve, but is uncommon in developed countries. Heart failure complicating rheumatic heart disease in pregnancy has been described in 22% women presenting to clinics in India and few African countries.

OBSTETRIC OUTCOME IN PREGNANCY WITH HEART DISEASE

Background: Pregnancy associated with any form of heart disease is a challenge for both obstetrician and cardiologist. The advancement in surgical techniques & minimal invasive surgeries have improved the prognosis of congenital lesions and many women even with severe defects are now reaching the child-bearing age. The number of pregnant women with coronary disease is expected to grow due to advanced maternal age and increased cardiovascular risk factors in women. Materials and Methods:This study was carried out in the department of Obstetrics and Gynecology in Lal Ded Hospital,an associated hospital of GMC,Srinagar.All the patients admitted in antenatal ward and delivered at period of gestation 28th weeks and beyond during the study period of 2019-2020 were included in the study. Results: Primigravida accounted for the majority group of heart disease with pregnancy and majority (90%) of them delivered at term and 10% had preterm delivery.Cardiac complications like pulmonary hypertension and congestive cardiac failure were present in 13.3% of cases. Conclusions:Rheumatic heart disease still remains the most common cardiac problems found in pregnant women. The incidence of heart disease in pregnancy was found to be 0.2% and majority of them belonged to 30-39 years group,un-booked and from rural background.

Characteristics shifting of heart disease in pregnancy: A report from low middle-income country

Background: Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country.Design and methods: A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding their gestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameters, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups.Results: The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD.Conclusion: Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.

Heart disease in pregnancy

Heart disease are common condition in pregnant women. Even, some of the cases diagnose just during the pregnancy. In this article, we summarize common cardiac disorders, which might encounter during the pregnancy and after birth. Furthermore, we discuss some etiological factors, pathophysiology, clinical manifestation, treatment and outcomes of the cardiac disease in pregnancy.

FETOMATERNAL OUTCOME OF PREGNANCY WITH HEART DISEASE IN A TERTIARY CARE HOSPITAL OF KOLKATA IN EASTERN INDIA

BACKGROUND: Heart disease in pregnancy is still a major problem worldwide, particularly in low resource country like India. Its reported incidence varies between 0.1 to 4%. Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the rheumatic heart disease (RHD) contributes to approximately 70% of heart disease seen in pregnancy. Heart disease in pregnancy is associated with adverse fetomaternal outcome and has re-emerged as one of the leading causes of maternal mortality. The maternal mortality rate in women with cardiac disease is 7% and morbidity is 30% during pregnancy in India. METHODS: This study was a prospective observational study conducted in the IPGMER & SSKM Hospital, Kolkata, West Bengal from December 2020 to February 2021. 36 Pregnant women with heart disease were taken as study group. Multiple pregnancy and any other medical disorder like GDM, PIH, were excluded from study. Fetomaternal outcome, mode of delivery, prematurity, LBW, NICU admission and maternal and neonatal mortality were compared. Template was generated in MS excel sheet and analysis was done on SPSS software. RESULTS: Among 36 patients 14 (38.89%) patients belonged to age group 25-29 years and 2 (5.56) belonged to age group <20 years. 13 (36.11%) patients belonged to lower middle class and 17 (47.22%) belong to lower class. 19 (52.78%) patients were P and 9 (25%) were P parity group. 20 (55.56%) belong to gravida G1. 10 (27.78%) 0+0 1+0 patients had CHD and RHD. 20 (55.56%) were normal delivery. 13 (36.11%) of babies were underweight. Maternal death were 2 (5.56%). CONCLUSIONS: Feto-maternal outcome can be improved appreciably by antenatal care, early diagnosis and management.

A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

Background: Prevalence of heart disease in pregnancy vary from 0.3-3.5%. Normal pregnancy is associated with physiological cardiovascular changes. These changes may unmask underlying cardiac disease in normal women and increase morbidity and mortality in women with heart disease. Heart disease in pregnancy is an important cause of maternal mortality in India. The aim of this study was to evaluate the maternal and neonatal outcome of pregnancy with heart disease.Methods: A prospective observational study was conducted at Sassoon General Hospital, Pune, India. 75 patients who fulfilled the inclusion criteria were studied. Maternal and neonatal outcome were analyzed.Results: Maternal heart disease was classified into congenital (36%) and acquired (64%). In acquired variety, rheumatic heart disease was most commonly seen. In congenital, ASD was most common. We divided the cases into two groups based on their NYHA status, low risk group had 74.67% patients and high risk group had 25.33% patients. The most common antenatal complication was PROM (41.3%). There was statistically significant association between ICU admission and high-risk group. The most common neonatal complications were IUGR and prematurity. Maternal mortality rate in the study group was 6.6%.Conclusions: The perinatal outcome of heart disease in pregnancy is more dependent on the severity of symptoms rather than the duration and type of heart disease. Multidisciplinary evaluation is necessary. Suboptimal optimization of the heart condition in the antenatal period and delayed referral were the major risk factor for maternal mortality.