The Spectrum of Heart Disease in Pregnancy and its Outcome in Patients Visiting a Tertiary Care Centre of Northeastern: A Prospective Study

Abstract

Introduction: An increased prevalence of cardiovascular disease has been found in women of child bearing age which varies between 0.3-3.5%. Heart diseases are the most significant non obstetrical causes of maternal deaths accounting for as much as 20.5% of all cases. Heart disease in pregnancy is a high risk condition with increased risk of maternal and foetal morbidity and mortality; hence it mandates a multidisciplinary approach. Aim: To find out prevalence, spectrum of disorder and outcome in pregnancy with heart disease in a tertiary care centre in North Eastern India. Materials and Methods: In this prospective hospital based, time bound study all pregnant women or puerperia with heart disease during the study period were followed up throughout pregnancy and their feto-maternal outcomes were compared with equal number of women without heart disease. Based on the symptoms all the patients were classified according to New York Heart Association (NYHA) functional classification. Patients were evaluated for development of any cardiac complication, obstetrical complication, and perinatal outcomes. Statistical analysis was performed using the SPSS software package (version 16.0). Results: Total number of pregnant women with heart disease was 55 and prevalence of heart disease in pregnant women admitted during the study period was found to be 2.32%. Congenital heart disease was the most common encountered type 49.09% followed by Rheumatic Heart Disease (RHD) 41.82%. Cardiac complications were present in 18% women and most common complication was congestive cardiac failure (80%). Preterm delivery was significantly higher among the cases (25%). Instrumental deliveries were higher among the cases (23.06% vs. 7.6%). The foetal outcome (live birth) was significantly better in controls. Low birth weight was higher among the cases (34.61% babies among cases and 12.73% babies among controls). Out of all maternal deaths, 10.34% were attributed to cardiac cause. All three mothers who died belonged to NYHA Class 4 and were anaemic. Conclusion: There is a significant shift in trends of spectrum of heart disease with congenital emerging as predominant lesion. This signifies an important change in the trends and spectrum of cardiac disease in our institute with lower incidence of RHD. With better health facilities, pregnant women with congenital heart disease will continue to rise and hence expertise in management of such conditions is imperative in times to come.

Keywords

• congenital heart disease
• maternal morbidity
• maternal mortality
• perinatal outcome
• rheumatic heart disease