Cardiac diseases with pregnancy ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Original Research Article

Cardiac diseases with pregnancy - A study of

maternal and fetal outcome
Tushar M Shah1, Keeranmayee Mishra2*, Pallavi Ninama1, Chirag
Parikh1
1
Assistant Professor,, Department of Obstetrics and Gynecology, B J Medical College, Ahmedabad,
India
2
Resident, Department of Obstetrics and Gynecology, B J Medical College, Ahmedabad,
Ahmedabad India
*Corresponding author email: keeran.subham@gmail.com
How to cite this article: Tushar M Shah,
Shah Keeranmayee Mishra, Pallavi Ninama, Chirag Parikh.
Parikh Cardiac
diseases with pregnancy - A study of maternal and fetal outcome.
outcome IAIM, 2015;
5; 2(1):
2(1
Available online at www.iaimjournal.com
Received on: 04-11-2014
2014 Accepted on: 17-12-2014

Abstract

Background: Total 0.2-4%4% of all pregnancies is complicated by cardiac diseases.

diseases In non western
countries, rheumatic heart diseases (RHD)
( constitute 56-89% off the cases and congenital
c heart
diseases only 9-19%.
Aim and objectives: To review all obstetric patients with co-existing
existing cardiac diseases admitted to a
tertiary care center over a period of one year and ascertain the causes of admissions and the
maternal and perinatal morbidity and mortality.
Material and methods: A retrospective, analytical study of all patients with cardiac diseases who
delivered over a period of January 2013 20 to December 2013 was conducted.
cond A tabulated
representation of the data was done. The various cardiac diseases were categorized according to
their severity, NYHA category, type of pathology, the maternal and perinatal outcome was assessed
and maternal mortality and perinatal mortality
mortal was recorded.
Conclusion: Total 69% cardiac lesions in pregnancy
pregnancy were rheumatic in origin and 15% belonged to
high risk category while 13.1% were NYHA type IV. Total 69% deliveries were by vaginal route.
Epidural analgesia preferred in LSCS of cardiac patients. Perinatal and maternal complications were
observed to increase with increase in NYHA class.

Key words

Cardiac diseases, Rheumatic, Obstetric.

International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015. Page 1

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 Cardiac diseases with pregnancy
Introduction
Total 0.2-4% of all pregnancies is complicated by
cardiac diseases [1]. In non western countries,
rheumatic heart diseases (RHD
RHD) constitute 56-
89% of the cases and congenital
ongenital heart diseases
only 9-19% [2, 3]. Total 2.7 deaths per 1000
pregnancies are reported in pregnancies
complicated by cardiac diseases [4].
Aim and objectives
• To study the incidence, distribution
through parity and the prevalence of
various cardiac diseases in pregnancy.
• To classify those into three risk
categories i.e. low, moderate, high [5].
• To study the maternal and fetal
outcomes in each case.
Material and methods
A retrospective, analytical study of all patients
with cardiac diseases who delivered over a
period of January 2013 to December 2013 was
conducted. A tabulated representation of the
data was done. The various cardiac
c diseases
were categorized according to their severity,
NYHA category, type of pathology, the maternal
and perinatal outcome was assessed and
maternal mortality and perinatal mortality was
recorded. Total 59 cases out of 7053 deliveries
were studied.
Results and Discussion
Incidence of cardiac diseases was 8.36/1000
deliveries. The number of booked
ooked cases was 34
(57.6%). Most patients were primi para (n=22,
37%). The majority belonged to an age group of
20 years to 25 years (53%). According to the
type of cardiac disease, valvular heart diseases
constituted the majority of cases (95.3%,
( n=41
International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.
Copy right © 2015,, IAIM, All Rights Reserved.
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
cases) of which (41/43 cases) were rheumatic in
origin. Out of 41 cases, isolated mitral stenosis
(MS) constituted 85% of cases, combined
valvular diseases 14.6% of cases and mitral valve
prolapse 4.8% of cases. Total 11.6% (5 cases)
had undergone balloon mitral valvoplasty
preconceptionally, 30.23% (13
( cases) developed
secondary pulmonary hypertension. All lesions
of rheumatic origin
in were on Injection
Inj Penidura
intramuscularly (IM) every 21 days.
There were cases of congenital
congeni heart diseases
that was nearly 15% (n=9) of total. They could
be further classified as cyanotic (62.5%, n=5
cases), all of which were atrial septal defects
which
hich could further be classified into osteum
secundum type (n=4) (majority
majority) and sinus
venosus type (n=1). Total 37.5% (n=3) cases of
congenital heart diseases were acyanotic in
nature. Two of these were cases of Ebstein
Anomaly and one was Tetralogy of Falot.
Fal Total 2
patients out of 9 with congenital heart diseases
(25%), had undergone mitral valve replacement
(MVR).
Total 19 patients (32%) had developed
secondary pulmonary hypertension which could
further be divided into mild (n=9), moderate
(n=6) and severe (n=3) and one case of
Eisenmenger Syndrome. There were 11% (n=7)
cases with cardiomyopathies of which two were
of dilated cardiomyopathies and five cases were
of peripartum cardiomyopathies.
The various maternal complications could be
classified
assified into obstetric and cardiac types.
Coming to the fetal outcome we observed that
there was higher incidence of preterm delivery
(19%) and a higher incidence (17%) of low birth
weight neonates.
Total 69% cardiac lesions in pregnancy
pre were
rheumatic in origin and 15% belonged to high
risk category and 13.1% were NYHA Type IV.
Page 2
 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Total 69% deliveries were by vaginal route. et al. Expert consensus document on
Epidural analgesia preferred in lower section management of cardiovascular diseases
cesarean section (LSCS). Perinatal and maternal during pregnancy. The task force on the
complications increased with increase in NYHA management of cardiovascular diseases
class. Infective endocarditis prophylaxis was during pregnancy of the European
given in all cases empirically.. Anticoagulation Society of Cardiology.
Cardiology Eur Heart J, 2003;
was offered in two cases with prior mitral valve 24: 761-781.
replacement. The rate of both preterm birth and 4. Bonow RO, Carabello BA, Kanu C, et al.
perinatal mortality was high. (Chart 1 to 9) ACC/AHA 2006 guidelines for the
management of patients with valvular
Conclusion heart disease: a report of the American
College of Cardiology/American Heart
Cardiac diseases take a heavy toll on both Association Task Force on Practice
maternal and fetal health. A multi disciplinarian Guidelines (writing
writing committee to revise
approach is ideal in dealing with and preventing the 1998 Guidelines for the
complications. Counselling for contraception Management of Patients With Valvular
and family planning and follow up during Heart Disease): developed in
subsequent pregnancies is mandatory.
ndatory. collaboration with the Society of
Cardiovascular Anesthesiologists:
endorsed by the Society for
References
Cardiovascular Angiography and
Interventions
ntions and the Society of
1. B M Weiss, et al. Outcome of Thoracic Surgeons. Circulation, 2006;
cardiovascular surgery and pregnancy.
pregnancy 114: e84–e231.
Am J Obst And Gyn, 1998; 179: 1643- 5. Mazghar, et al. Maternal cardiac
1653. complications in women with cardiac
2. Stangl V, Schad J, Gossing G,G Borges A, diseases. J Coll. Phy Surg Part I, 2005;
Baumann G, Stangl K. Maternal heart 5(8): 476-480.
disease and pregnancy outcome: a
single-centre
centre experience. Eur J of Heart
Fail, 2008; 10(9): 855-860.
860.
3. Task Force Members, Celia Oakley, Anne
Child,
ild, Bernard Iung, Patricia Presbitero,

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 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Chart – 1: Distribution
istribution according to risk classification.
classification

LOW RISK
• 31 CASES
MMR: <1%

MODERATE RISK
• 19 CASES
MMR: 5-15%

HIGH RISK
• 9 CASES
MMR: 25-50%

Chart – 2: Distribution according to NYHA grading [4].

25

20

15

10

0
NYHA I NYHA II NYHA III NYHA IV

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 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Chart – 3: Pregnancy
regnancy outcome in each case.
case

35
35

30

25

20

15
11
10 NORMAL
6 OPERATIVE
5
5 3 VBAC
2
OBSTETRIC
0 CARDIAC
VAGINAL LSCS MTP
SUCTION

Chart – 4: Pregnancy outcome.

MTP
3%
EM LSCS
9 CASES

EL LSCS
NORMAL
7 CASES
69%

43 CASES

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 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Chart – 5: Obstetric
bstetric complications.
complications

BLOOD
TRANSFUSION, 6
6
PPH, 4
4
EPISIO
2 HEMATOMA, 1

Chart – 6: Cardiac
ardiac complications in course of pregnancy.
pregnancy

8
8

4 3
2 2 2 2
2

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 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Chart – 7: Maturity
aturity of newborn infants.
infants

19%

full term delivery

81%
pre-term delivery

Chart – 8: Distribution
istribution of birth weight of neonates.
neonates

2.10%

11.80%

10%

60.70% 16.90%

<1 kg
1.1 to 1.5 kg
1.6 to 2 kg
2.1 to 2.5 kg
> 2.5 kg

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 Cardiac diseases with pregnancy ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Chart – 9: Perinatal outcome.

13
14
12 9
10 6
8 4
6 2 2
4
2
0

Source of support: Nil Conflict of interest: None declared.

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