Heart India (Jan 2019)

Critical analysis of all pregnancies with heart disease, misses and near misses over 1-year period along with expert group so as to optimize outcome and improve patient care – Need-based analysis

  • Shuchi Agrawal,
  • Avinash Agrawal,
  • Monika Bhandari,
  • Suhail Sarwar Siddiqui,
  • Sciddharth Koonwar

DOI
https://doi.org/10.4103/heartindia.heartindia_15_19
Journal volume & issue
Vol. 7, no. 2
pp. 55 – 62

Abstract

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Introduction: Cardiac disorders complicate approximately 1%–3% of pregnancies and present a real challenge to treating healthcare providers.Maternal mortality may be as high as 7% when New York Heart Association (NYHA) Classes III and IV patients are combined. In contrast, Classes I and II combined yield a mortality of 0.5%. Similarly, fetal mortality maybe as high as 30% in Class III and IV patients, in contrast to 2% for Classes I and II. Managing pregnant patients with complex cardiac disease mandates participation from a multidisciplinary team early in the pregnancy. Audit of misses and near misses helps to determine causes of maternal mortality and morbidity and identify gaps in care. Aims and Objectives: To assess burden of maternal cardiac disease and its influence on maternal and fetal outcome. To assess gaps in multidisciplinary care and to analyze causes associated with increased morbidity and mortality. Methods: A retrospective analysis of all pregnant patients with heart disease admitted to department of obstetrics and gynecology at tertiary care center from January 2017 to January 2018. Results: Of 9563 deliveries, there were 108 cases of pregnancy with heart disease (1.12%). Majority of patients in study cohort belonged to low socioeconomic status and had rural background. 36 patients (33.33%) were primi-gravida; majority presented for antenatal care in the third trimester. 82 (75.92%) in functional Class (NYHA) I – II, predominant cardiac lesion was rheumatic valvular disease diagnosed in 101 patients (93.5%); 60 patients (58.82%) had vaginal delivery, 63 (64%) were delivered before 37 weeks and 6 patients had medical termination of pregnancy. 10 patients (9.2%) developed cardiac failure and 8 (7.4%) had atrial fibrillation. There were 4 maternal death and 8 near misses. Conclusion: The present study highlights need of training of physicians and obstetrician working at peripheral centres for early diagnosis, timely referral and strengthening pre-pregnancy counselling.

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