Pregnancy and Congenital Heart Disease - Maternal and Fetal Outcome (original) (raw)
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Maternal and Fetal Outcome in Pregnancies with Heart Disease
Journal of medical science and clinical research, 2016
Aims and objectives 1. To assess the maternal outcome of pregnancies complicated by heart disease. 2. To assess the foetal outcome of pregnancies complicated by heart disease. Study Design: It was a prospective, observational study conducted at department of obstetrics and gynaecology in a tertiary care hospital over a period of two years. Materials and methods: The study was approved by the Institutional ethical committee. All patients who have cardiac disease in pregnancies admitted in obstetrics and gynaecology department of our institute and were willing to participate in the study were enrolled. Those patients who were admitted in our institute in postpartum period and those who were not willing to participate in this study were excluded from the study. Women enrolled in this study were examined during antenatal or peripartum period (depending upon when they first visit our institute) and classified on the basis of New York heart association (NYHA) functional classification. In admitted patients indication of admission, complications associated with heart disease and shift of NYHA class, if any, were noted. Routine tests and special tests like ECG and 2DECHO were done. Fetal well being was also assessed. Mode of delivery and neonatal outcome was recorded according to the proforma. During postnatal period all patients were followed up to discharge from hospital for any obstetrical, cardiac and neonatal complications. Details of maternal and neonatal morbidity and mortality were noted. Results: in this study the incidence of heart disease was found to be 0.69%. Mean age at presentation was found to be 24 +/-3.4 years. Maximum patients belonged to age group 21-25 years. Majority of the patients (77%) were primigravida. Most of the patients (31.46%) were admitted in hospital during 34-37 weeks of gestation. The most common complaints for which the patients were admitted was breathlessness (58.87%) and labour pains (22.58%). A NYHA based classification revealed that most of the patients (70.96%) were NYHA grade I while grade II, III and IV were 13.7% ,11.31% and 4.03% respectively. Most common etiology of heart disease in studied subject was found to be rheumatic (66.94%) in origin followed by congenital (24.19%) and peripartum cardiomyopathy (5.66%). In patients having rheumatic valvular heart disease most common isolated valvular involvement was seen in the form of mitral stenosis (14.5%) followed by mitral regurgitation (6.45%) and tricuspid regurgitation (5.64%). Rest of the patients had multiple valvular lesions involving mitral,tricuspid and aortic valves. In patients who had congenital heart disease most common
Maternal and fetal outcome in pregnancy with heart disease
Background Cardiac disease in pregnancy still remains a major problem worldwide, particularly in developing countries like ours. The reported incidence of cardiac disease varies between 0.1 and 4%, and remains a significant cause of maternal death worldwide. The objective of this research was to analyse the incidence of cardiac disease in pregnancy in our hospital and to assess the maternal and foetal outcome. Material and methods A retrospective study was carried out in 78 women with cardiac disorders during the period of 18 months in the Maternal and foetal outcome was analysed, Data were collected and presented as number and percentage. Results Prevalence of heart disease was found to be 2.3%. The Rheumatic Heart disease was the principal cause of heart disease followed by Congenital heart disease. Among the women who had Rheumatic heart disease, Mitral Valve stenosis was the most common lesion. Among the women with congenital cardiac disease, ASD was most common lesion followed by VSD. Although no maternal deaths were recorded during the study period, but a significant number of cardiac and non-cardiac complications were encountered. Most of the patients had vaginal delivery (61.5%) and caesarean section was seen mostly due to obstetric indication. Prematurity was the most common neonatal complication seen in 23.1% of babies. Conclusions Cardiac disease in pregnancy is a serious complication. Women with cardiac disease requires a multidisciplinary teamwork to have optimal maternal and foetal outcome. Hence, there is requirement of constant vigilance throughout the antenatal, intrapartum and postpartum period inorder to avoid adverse outcomes.
Obstetric Outcome in Pregnancy with Heart Disease
Background: Pregnancy associated with any form of heart desease 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 Gynaecology in collaboration with department of medicine, Regional Institute of Medical Sciences, Imphal, Manipur. All the patients admitted in antenatal ward and delivered at period of gestation 28 th weeks and beyond during the study period of November 2014-April 2016 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 in our country. The incidence of heart disease in pregnancy was found to be 0.2% and majority of them belonged to 30-39 years group, unbooked and from rural background.
Maternal and perinatal outcome of pregnancies complicated by cardiac disease
International Journal of Gynecology & Obstetrics, 2005
Objective: The aim of this study was to assess the maternal and perinatal outcome of pregnancies complicated by cardiac disease in a tertiary care center in Egypt. Methods: During a 1-year period, a total of 86 pregnant women with cardiac disease were admitted. Maternal and perinatal morbidity and mortality were calculated and compared with a control group. Results: Seventy-seven (89.5%) patients were due to rheumatic affection, and 60 patients were classified as NYHA classes I-II. There was one case of maternal mortality (1.16%), and 10 other cases developed lifethreatening complications. Two perinatal mortalities (2.32%) occurred in this series. Birth weight of babies born to mothers with functional classes III and IV were significantly lower than those of functional classes I-II and control group. Conclusion: Rheumatic heart disease with pregnancy is still predominant in Egypt. Maternal and perinatal morbidity and mortality are strongly correlated to maternal cardiac functional classification.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Objective of this study was to assess the prevalence of chronic rheumatic heart disease and congenital heart disease complicating pregnancy, study the maternal and perinatal outcome, and indications for termination of pregnancy.Methods: Preconception counseling, antenatal care by pregnancy heart team as per protocol. One 2nd gravida (G2A1) with 26 weeks gestation, underwent mitral valve replacement during 26th week gestation i/v/o infective endocarditis associated with severe mitral regurgitation.Results: Authors had CRHD: CHD = 29:21, out of 50 cases, the ratio was 1.3:1 in this study. Atrial septal defect (ASD) was the predominant lesion in this study -29% ASD alone and 9% associated with pulmonary artery hypertension. Eisenmenger's syndrome, was associated with ASD in three and VSD in two. Corrected lesions were 24%. In the rheumatic heart disease, mitral stenosis was the predominant lesion and PBMV was done in four (13.7%) cases. In CRHD cases, surgically correct...
Cardiac diseases in pregnancy and its feto-maternal outcome
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Cardiac disease complicates 1-3% of all pregnancies. Of this Rheumatic heart disease constitute 74% and congenital heart disease 26%.Methods: A retrospective study of all patients with cardiac diseases delivered was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according the severity, NYHA classification, type of pathology, the maternal and perinatal outcome was assessed, and the maternal mortality and perinatal mortality was recorded.Results: 84% patients belonged to age group 20-29 years. 8% were teen aged and 4% patients were elderly. 64% patients were either P0+0 or P0+1. 8% patients were P0+3 and 2% patient were P3+0. 74% patients had RHD. 26% had grade I, 40% had grade II, 20% patients had grade III and 14% had grade IV heart disease. The associated complications were anemia 46%, Respiratory tract infection 12%, pregnancy induced hypertension 2% and recurrent rheumatic fever 2%. 48% had normal vaginal deli...
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2009
To study maternal and perinatal outcome in congenital heart disease (CHD) and to compare outcome between cyanotic and acyanotic CHD. Method: A retrospective analysis of 196 cases of CHD was undertaken, and maternal and perinatal outcome of pregnancy was compared in cyanotic and acyanotic cases and between surgically corrected and uncorrected cases. Results: Maternal and perinatal outcome was better in the acyanotic group. Maternal complications included higher incidence of cardiac complications in cyanotic group, (33.3% vs 3.4% in acyanotic group, P = 0.001), abruption (12.5% vs nil) and pregnancyinduced hypertension (16.6% vs 5.2%). Rate of prematurity (25% vs 11.6%), intrauterine growth retardation (50% vs 15.1%, P = 0.003) and abortion (4.1% vs 2.1%) was higher in cyanotic group. Mean gestational age at delivery was better in corrected group, 37.13 vs 34.93 weeks in uncorrected group. There was no case of infective endocarditis. There were four cases of maternal mortality in cyanotic group, two of which were in women with Eisenmenger syndrome. In acyanotic heart disease one case died undelivered and one died on first postoperative day. Conclusion: Maternal and perinatal outcome is better in acyanotic CHD compared to cyanotic CHD. Surgical correction of cardiac lesions prior to conception improves outcome.
Prospective evaluation from single centre of pregnancy in women with congenital heart disease
International Journal of Cardiology, 2009
Study of outcomes of pregnancy in women with congenital heart disease. The cardiac state during and after pregnancy was analysed in 173 women (mean age 28 years, range 21-41) referred for fetal echocardiography and evaluation of maternal heart during 201 pregnancies. Acyanotic lesions were present in 152 women (100 operated), in 175 pregnancies; cyanotic lesions in 21, all operated, in 26 pregnancies. Eighteen patients in 20 pregnancies (9.9% pregnancies) presented an increased risk due to severe arrhythmias or relevant residual hemodynamic lesions (risk group). Complications related to heart defects occurred in 9/201 (4.5%), pregnancies: in 6/175 (3.4%) pregnancies with acyanotic lesions, in 3/26 (11.5%) with cyanotic lesions and in 9/20 pregnancies of the risk group (45%), with a statistically significant difference with respect to the non-risk group. Two cases had serious tachyarrhythmias, five worsened hemodynamic state or cyanosis, one had hemorrhage post-partum on anticoagulants and one died of a rupture of isthmic aneurysm post-coarctectomy. Prematurity occurred in 19.2% of pregnancies with cyanotic and 5.7% with acyanotic lesions. There were 6/201 recurrences of cardiac anomaly (3%). Patients with uncomplicated heart disease had normal course of pregnancy, while complications due to serious arrhythmias or residual hemodynamical lesions and cyanosis occurred in 4.5% of pregnancies and, mainly in 45% of those with increased risk. Thorough evaluation of the cardiologic risk is mandatory for a correct counseling of women planning pregnancy.
Cardiac disease in pregnancy. Part 1: congenital heart disease
The Obstetrician & Gynaecologist, 2007
• Heart disease is now the most common indirect cause of maternal death in the United Kingdom. • Neonatal morbidity and mortality from fetal growth restriction and prematurity are markedly increased in women with heart disease. • Women with congenital heart disease should ideally have a planned pregnancy managed by a multidisciplinary team which includes obstetricians, cardiologists, anaesthetists, neonatologists and midwives. Learning objectives: • To understand the changes to cardiovascular physiology during pregnancy. • To recognise the risk factors for poor pregnancy outcome in cardiac disease. • To understand the general management principles for women with cardiac disease in pregnancy. Ethical issues: • Should we be recommending termination of pregnancy in women with high risk cardiac lesions? • How do we manage women who become pregnant against medical advice? • What is the role of surrogacy in women with high risk cardiac lesions?
Pregnancy with congenital heart disease
Vessel Plus, 2022
Pregnancy is complicated by maternal cardiovascular disease in 1%-4% of cases. With advances in management of congenital heart diseases (CHDs), the survival to adulthood and childbearing age is increasing all over the world. The physiological adaptation during pregnancy adds to the hemodynamic burden of CHD, and, hence, many women are diagnosed with CHD for the first time during pregnancy, more so in developing countries. The type of underlying CHD and pre-pregnancy hemodynamics determine the risk of developing complications during pregnancy. Hence, pre-pregnancy risk stratification and counseling are a crucial part of management plan. Some of the serious CHDs are best treated in the preconception stage. The maximum chance of developing complications is between 28 and 32 weeks of gestation, during labor, and up to two weeks after delivery. Common complications in women with CHD during pregnancy and labor include heart failure, arrhythmias, bleeding/thrombosis, infective endocarditis, and rarely maternal death. Fetal complications include abortion, stillbirth, prematurity, low birth weight, and CHD. Comprehensive knowledge of these complications and their management is very important as an experienced multidisciplinary team is critical for improving outcome of these patients. Special care is required for pregnant women who have pulmonary hypertension, due to either Eisenmenger syndrome or other causes, severe valve stenosis, aortopathy associated with bicuspid aortic valve/coarctation, or severe cyanotic CHDs. Most women with CHD are at low risk, and successful pregnancy is feasible in the majority with optimal management.