Heart Disease in Pregnancy-Evaluation of Spectrum, Association of Predictors with Obstetric Outcome and Need for Comprehensive Medical Care

Abstract

Introduction: Cardiac disorders of varying severity complicate nearly 1% of pregnancies and are an important cause of maternal morbidity and mortality. It is important to define the risk stratification of women with heart disease for optimal prepregnancy counselling and obstetric management. Aim: To study the spectrum of heart disease in pregnancy, identification of various predictors of feto-maternal complications and comparison of the obstetric outcome in women with heart disease who received Comprehensive Medical Care (CMC) beginning at ≤28 weeks, with those who began Antenatal Care (ANC) supervision after 28 weeks. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology in Safdarjung Hospital (SJH), New Delhi, India, from October 2014 to March 2016. Pregnant women with heart disease attending the OPD/or delivering in labour room were scrutinised through the eligibility criteria. Out of the 66 eligible women, beginning antenatal supervision at ≤28 weeks of gestation were designated as Group A (n=32) who received CMC. Remaining women (n=34), who supervised after 28 weeks in the hospital for further management were designated as Group B. Analysis was done after applying appropriate tests: t-test, Chi-square test and univariate analysis, as applicable. Results: Incidence of heart disease was 0.35% (71/21,000), out of which Rheumatic Heart Disease (RHD) was predominant. Left heart obstruction was the most common (29/66) predictor for adverse maternal cardiovascular and neonatal event, followed by baseline New York Heart Association (NYHA) Class>II (22/66). Cardiac complications were 2.4 times higher and cardiac mortality was ~3 times more in Group B as compared to Group A. Neonatal mortality occurred in 5.6% (2/36) women in Group B. Conclusion: All pregnant women with heart disease should receive comprehensive multidisciplinary prenatal care. Early ANC supervision and extra prenatal surveillance is recommended according to pregnancy associated risk status. Women with ≥1 predictor of cardiac and neonatal events should be referred to a tertiary care centre for CMC.

Keywords

• antenatal care
• cardiac disease in pregnancy
• risk stratification