Publication:

Pregnancy outcome in women with heart disease at a tertiary referral teaching center in Northern India

Background Pregnancy causes a significant burden on cardiovascular system due to hemodynamic changes therefore a diseased heart may not be able to adjust with extra load resulting in heart failure and even maternal mortality.

Methods A prospective study was done in 50 women with heart disease over a period of 12 months from 2010 to 2011 at G.S.V.M. Medical College, Kanpur. At the first antenatal visit baseline data is recorded included age, parity, gestational age, NYHA class, co-morbid conditions, prior cardiac events, cardiac lesion (if already diagnosed), prior surgery/interventions, cyanosis and medications. A thorough clinical examination and investigations were done.

Results Maximum numbers of patients (56%) were in the age group 20-24 years. 52 % of patients were primigravida and 48 % of patients were multigravida. Maximum numbers of patients (76.67%) were in the lower socioeconomic group. Chronic rheumatic heart disease (84%) was the most common type of heart disease followed by congenital cardiac disease (14%). Heart disease if diagnosed preconceptionally or during earlier period of gestation both maternal (8.9%) and foetal complications (22.8%) are lesser as compared to patients in whom diagnosis was made late. There is also the significant difference with majority of the foetal complications in group IV (80%) (preterm birth, IUGR and perinatal mortality) as compared to group I (14.2%).

Conclusions Maternal and perinatal outcome in women with heart disease depends mainly on the functional cardiac status during pregnancy, the risk being greater in NYHA III and IV. Our study shows that surgical intervention or medical management in pregnancy improves the functional class and also improves the maternal and fetal outcomes. Interventions can only be successfully done either before pregnancy or during 2nd trimester. When patients were diagnosed before pregnancy we have enough time for counseling and treatment. Counseling further increase the compliance and acceptance for medical and surgical interventions.