Outcome of Newborns Born to Mothers with Heart Disease by Operative Mode of Delivery – A Study from South India

Abstract

Context: Heart disease complicates approximately 1% of all pregnancies. Maternal cardiac disease in pregnancy has a bearing on pregnancy course and neonatal outcomes. Indian studies in this regard are sparse and moreover were undertaken mostly by obstetricians. Aims: The present study was planned looking from a paediatrician’s perspective in order to study all possible neonatal outcomes born to mothers with heart disease delivered by operative mode. Settings & Design: The data consisted of retrospective (old patient records with obstetric and cardiac details including echocardiography reports) and prospective data (monitored from the first antenatal visit to the delivery regularly by obstetricians and cardiologists) conducted in a multispeciality hospital including a tertiary care cardiac centre. Materials and Methods: Pregnant women with Congenital Heart Disease and Rheumatic Heart Disease and their newborns born by caesarean section were enrolled from 2006 - 2010. These women were treated according to their New York Heart Association (NYHA) class to improve their cardiac status. The neonatal group was followed for certain events (outcome) from delivery till discharge. These outcomes were compared between the test group (mothers with cardiac risk factors, unoperated mothers and those without drugs) and the control groups (mothers with no cardiac risk factors, operated mothers and those on drugs). Statistical Analysis used: SPSS v 17 software was used for statistical analysis. Descriptive analysis, Chi Square test and multiple logistic regression were used. Statistical level of significance was fixed at p < 0.05. Results: 55 pregnant women with heart disease and their 55 newborns were seen. Neonatal outcome was adverse in 58% babies; 47% were born to mothers with cardiac risk factors. 25 newborns (45%) had low birth weight, 15 (27%) were preterm, 20 (36%) had jaundice. 18 (33%) were small for gestational age, 8 babies (15%) had congenital anomalies (cardiac - 7; non cardiac – 3). 21% of babies with CHD were born to mothers with CHD. There were 2 neonatal deaths (4%). Statistically significant outcome was found with respect to prematurity only. 33% mothers had one or more of the 5 cardiac risk factors. There was no difference in neonatal outcomes between mothers with RHD or CHD. Conclusion: The outcome of newborns is influenced by maternal cardiac risk factors. There were no differences in neonatal outcomes born to mothers with RHD and CHD and mothers with operated and unoperated heart disease.

Keywords

• co-morbidities
• cardiac risk factors
• maternal heart disease
• neonatal outcomes
• prematurity