Spectrum, Prevalence and Fetomaternal Outcome of Cardiac Diseases in Pregnancy: A Single Center Tertiary Care Experience

Abstract

Introduction: Cardiovascular Disorders (CVD) are significant cause of fetomaternal morbidity and mortality. Prevalence of CVD in pregnancy is less than 1% (varies from 0.3-3.5%). Aim: To study spectrum, prevalence and fetomaternal outcome of cardiac diseases in pregnancy at a tertiary care center. Materials and Methods: A retrospective study was conducted in which data of all antenatal patients visiting the hospital over a period of 27 months from March 2017 to June 2019 were analysed for cardiac diseases by clinical history, examination, Electocardiograpy and echocardiography. Type, Severity of heart disease was noted as per New York Heart Association (NYHA) criteria. Maternal outcome recorded in terms of Maternal death, Congestive Cardiac failure requiring ICU Care, Pregnancy Induced Hypertension, Antepartum Haemorrhage, Postpartum Haemorrhage, Deep vein Thrombosis, Anaemia and termination of pregnancy. Fetal outcome was recorded in terms Live Birth, Pre Term, Low Birth Weight, Intrauterine Death, Neonatal Death, Acute Fetal distress and Abortion. Results: A total of 9298 pregnant females were screened. A total of 73 had cardiac disease, with a based prevalence of 7.85/1000. About 22 (30.13%) patients were diagnosed first time during pregnancy. Mean age was 27.46±4.4 years. Thirty two (45%) were primigravida. About 58(80%) were in either NYHA Class I or II. Rheumatic Heart Disease (RHD) was the most common {36 (46.5%)} cardiac disorder. Maternal mortality occurred in 3 (4.1%) patients. Cardiac failure occurred in 10 (13.6%) patients. Fetal outcome included abortion in 1 (1.36%), acute fetal distress in 5 (6.84%), Intrauterine death in 2 (2.73%), Low birth weight in 8 (10.9%), preterm delivery in 4 (5.4%) patients and neonatal mortality in 1 (1.36%). Medical Termination of Pregnancy (MTP) was done in 6 (8.2%) patients. Predictors of combined maternal & fetal morbidity and mortality were advanced NYHA Class (III & IV) (p=0.0001, OR 5.98 95% CI 1.2940 to 27.3424), severe left sided obstructive lesions (p=0.0001, OR 14.0 95% CI 3.8430 to 51.0019) and left ventricular dysfunction (p=0.0018, OR 18.27 95% CI 2.0982 to 159.2223). Conclusion: RHD was the most common cardiac disorder reflecting need of secondary antibiotic prophylaxis. Patients who present with higher NYHA class, severe LV dysfunction and severe left heart obstructive disease represent high risk group.

Keywords

• cardiovascular disorder
• morbidity
• mortality
• rheumatic heart disease