cardiac diseases with pregnancy - a study of maternal and fetal outcome
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Tushar M Shah, Keeranmayee Mishra, Pallavi Ninama, Chirag Parikh. Cardiac diseases with pregnancy - A study of maternal and fetal outcome. IAIM, 2015; 2(1): 22-29.TRANSCRIPT
Cardiac diseases with pregnancy
International Archives of Integrated Medicine, Vol.
Copy right © 2015, IAIM, All Rights Reserved.
Original Research Article
Cardiac diseases with pregnancy
maternal and fetal outcome
Tushar M Shah1, Keeranmayee Mishra
1Assistant Professor, Department of Obstetrics and
2Resident, Department of Obstetrics and
*Corresponding author email:
How to cite this article: Tushar M Shah
diseases with pregnancy - A study of maternal and fetal outcome
Available online at
Received on: 04-11-2014
Abstract
Background: Total 0.2% to 4% of all
countries, rheumatic heart diseases (
diseases only 9-19%.
Aim and objectives: To review all obstetric patients
tertiary care center over a period of one year and
maternal and perinatal morbidity and mortality.
Material and methods: A retrospective,
delivered over a period of January 20
representation of the data was done.
their severity, NYHA category, type of pathology,
and maternal mortality and perinatal mortal
Conclusion: Total 69% cardiac lesions in pre
high risk category while 13.1% were NYHA type IV.
Epidural analgesia preferred in LSCS
observed to increase with increase in NYHA class.
Key words
Cardiac diseases, Rheumatic, Obstetric.
diseases with pregnancy
International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.
, IAIM, All Rights Reserved.
Cardiac diseases with pregnancy - A study of
maternal and fetal outcome
, Keeranmayee Mishra2*
, Pallavi Ninama
Parikh1
, Department of Obstetrics and Gynecology, B J Medical College,
India
Resident, Department of Obstetrics and Gynecology, B J Medical College, Ahmedabad
*Corresponding author email: [email protected]
Tushar M Shah, Keeranmayee Mishra, Pallavi Ninama, Chirag Parikh
A study of maternal and fetal outcome. IAIM, 2015; 2(1
Available online at www.iaimjournal.com
2014 Accepted on:
4% of all pregnancies are complicated by cardiac diseases
rheumatic heart diseases (RHD) constitute 56-89% of the cases and c
To review all obstetric patients with co-existing cardiac diseases admitted to a
tertiary care center over a period of one year and ascertain the causes of admissions and the
maternal and perinatal morbidity and mortality.
A retrospective, analytical study of all patients with cardiac diseases who
over a period of January 2013 to December 2013 was cond
representation of the data was done. The various cardiac diseases were categorized according to
type of pathology, the maternal and perinatal outcome was assessed
and maternal mortality and perinatal mortality was recorded.
69% cardiac lesions in pregnancy were rheumatic in origin and
13.1% were NYHA type IV. Total 69% deliveries were
LSCS of cardiac patients. Perinatal and maternal complications were
observed to increase with increase in NYHA class.
Obstetric.
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 22
A study of
maternal and fetal outcome
, Pallavi Ninama1, Chirag
B J Medical College, Ahmedabad,
Ahmedabad, India
Chirag Parikh. Cardiac
5; 2(1): 22-29.
Accepted on: 17-12-2014
diseases. In non western
f the cases and congenital heart
existing cardiac diseases admitted to a
ascertain the causes of admissions and the
cardiac diseases who
December 2013 was conducted. A tabulated
The various cardiac diseases were categorized according to
the maternal and perinatal outcome was assessed
gnancy were rheumatic in origin and 15% belonged to
Total 69% deliveries were by vaginal route.
Perinatal and maternal complications were
Cardiac diseases with pregnancy
International Archives of Integrated Medicine, Vol.
Copy right © 2015, IAIM, All Rights Reserved.
Introduction
Total 0.2% to 4% of all pregnancies
complicated by cardiac diseases
western countries, rheumatic heart diseases
(RHD) constitute 56-89% of the cases and
congenital heart diseases only 9
Total 2.7 deaths per 1000 pregnancies are
reported in pregnancies complicated
diseases [4].
Aim and objectives
• To study the incidence,
through parity and the
various cardiac diseases in pregnancy.
• To classify those into three risk
categories i.e. low, moderate,
• To study the maternal
outcomes in each case.
Material and methods
A retrospective, analytical study of all patients
with cardiac diseases who delivered
period of January 2013 to December 2013 was
conducted. A tabulated representation of the
data was done. The various cardiac diseases
were categorized according to their severity,
NYHA category, type of pathology,
and perinatal outcome was assessed and
maternal mortality and perinatal mortality
recorded. Total 59 cases out of 7053 deliveries
were studied.
Results and Discussion
Incidence of cardiac diseases was
deliveries. The number of booked cases was
(57.6%). Most patients were primi para (n=22,
37%). The majority belonged to an age group of
20 years to 25 years (53%). According
type of cardiac disease, valvular heart diseases
diseases with pregnancy
International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.
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pregnancies are
diseases [1]. In non
rheumatic heart diseases
f the cases and
ongenital heart diseases only 9-19% [2, 3].
2.7 deaths per 1000 pregnancies are
reported in pregnancies complicated by cardiac
To study the incidence, distribution
through parity and the prevalence of
various cardiac diseases in pregnancy.
To classify those into three risk
moderate, high [5].
To study the maternal and fetal
analytical study of all patients
cardiac diseases who delivered over a
December 2013 was
A tabulated representation of the
various cardiac diseases
were categorized according to their severity,
type of pathology, the maternal
and perinatal outcome was assessed and
maternal mortality and perinatal mortality was
Total 59 cases out of 7053 deliveries
Incidence of cardiac diseases was 8.36/1000
ooked cases was 34
Most patients were primi para (n=22,
The majority belonged to an age group of
According to the
valvular heart diseases
constituted the majority of
cases) of which (41/43 cases)
origin. Out of 41 cases, isolated
(MS) constituted 85% of cases,
valvular diseases 14.6% of cases and mitral valve
prolapse 4.8% of cases. Total
had undergone balloon mitral valvoplasty
preconceptionally, 30.23% (
secondary pulmonary hypertension.
of rheumatic origin were on Inj
intramuscularly (IM) every 21 days.
There were cases of congeni
that was nearly 15% (n=9)
be further classified as cyanotic
cases), all of which were atrial septal defects
which could further be classified into osteum
secundum type (n=4) (majority
venosus type (n=1). Total 37.5%
congenital heart diseases were acyanotic in
nature. Two of these were cases of Ebstein
Anomaly and one was Tetralogy of
patients out of 9 with congenital heart diseases
(25%), had undergone mitral valve replacement
(MVR).
Total 19 patients (32%)
secondary pulmonary hypertension which could
further be divided into mild
(n=6) and severe (n=3)
Eisenmenger Syndrome. There were 11%
cases with cardiomyopathies of which two were
of dilated cardiomyopathies and five cases were
of peripartum cardiomyopathies.
The various maternal complications could be
classified into obstetric and cardiac types.
Coming to the fetal outcome we observed that
there was higher incidence of preterm delivery
(19%) and a higher incidence
weight neonates.
Total 69% cardiac lesions in pre
rheumatic in origin and 15%
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Page 23
constituted the majority of cases (95.3%, n=41
(41/43 cases) were rheumatic in
isolated mitral stenosis
85% of cases, combined
cases and mitral valve
Total 11.6% (5 cases)
had undergone balloon mitral valvoplasty
(13 cases) developed
secondary pulmonary hypertension. All lesions
in were on Injection Penidura
every 21 days.
cases of congenital heart diseases
of total. They could
be further classified as cyanotic (62.5%, n=5
of which were atrial septal defects
hich could further be classified into osteum
majority) and sinus
37.5% (n=3) cases of
congenital heart diseases were acyanotic in
Two of these were cases of Ebstein
Anomaly and one was Tetralogy of Falot. Total 2
patients out of 9 with congenital heart diseases
had undergone mitral valve replacement
Total 19 patients (32%) had developed
pulmonary hypertension which could
further be divided into mild (n=9), moderate
and one case of
There were 11% (n=7)
cases with cardiomyopathies of which two were
of dilated cardiomyopathies and five cases were
of peripartum cardiomyopathies.
The various maternal complications could be
to obstetric and cardiac types.
Coming to the fetal outcome we observed that
incidence of preterm delivery
and a higher incidence (17%) of low birth
69% cardiac lesions in pregnancy were
15% belonged to high
Cardiac diseases with pregnancy
International Archives of Integrated Medicine, Vol.
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risk category and 13.1% were
Total 69% deliveries were by vaginal route.
Epidural analgesia preferred in
cesarean section (LSCS). Perinatal and maternal
complications increased with increase in NYHA
class. Infective endocarditis prophylaxis
given in all cases empirically.
was offered in two cases with prior mitral valve
replacement. The rate of both preterm birth and
perinatal mortality was high. (Chart 1 to 9)
Conclusion
Cardiac diseases take a heavy toll on both
maternal and fetal health. A multi
approach is ideal in dealing with and preventing
complications. Counselling for contraception
and family planning and follow up during
subsequent pregnancies is mandatory.
References
1. B M Weiss, et al. Outcome of
cardiovascular surgery and pregnancy
Am J Obst And Gyn, 1998;
1653.
2. Stangl V, Schad J, Gossing G
Baumann G, Stangl K.
disease and pregnancy outcome: a
single-centre experience.
Fail, 2008; 10(9): 855-860.
diseases with pregnancy
International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.
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13.1% were NYHA Type IV.
by vaginal route.
Epidural analgesia preferred in lower section
Perinatal and maternal
complications increased with increase in NYHA
Infective endocarditis prophylaxis was
. Anticoagulation
was offered in two cases with prior mitral valve
The rate of both preterm birth and
(Chart 1 to 9)
take a heavy toll on both
A multi disciplinarian
ideal in dealing with and preventing
Counselling for contraception
and family planning and follow up during
ndatory.
B M Weiss, et al. Outcome of
cardiovascular surgery and pregnancy.
1998; 179: 1643-
Gossing G, Borges A,
Maternal heart
disease and pregnancy outcome: a
centre experience. Eur J of Heart
860.
3. Task Force Members, Celia Oakley, Anne
Child, Bernard Iung, Patricia Presbitero,
et al. Expert consensus document on
management of cardiovascular diseases
during pregnancy. The task force on the
management of cardiovascular diseases
during pregnancy
Society of Cardiology
24: 761-781.
4. Bonow RO, Carabello BA, Kanu C, et al.
ACC/AHA 2006 guidelines for the
management of patients with valvular
heart disease: a report of the American
College of Cardiology/American Heart
Association Task Force on Practice
Guidelines (writing committee to revise
the 1998 Guidelines for the
Management of Patients With Valvular
Heart Disease): developed in
collaboration with the Society of
Cardiovascular Anesthesiologists:
endorsed by the Society for
Cardiovascular Angiography and
Interventions and the Society of
Thoracic Surgeons.
114: e84–e231.
5. Mazghar, et al. Maternal cardiac
complications in women with cardiac
diseases. J Coll. Phy Surg Part I, 2005;
5(8): 476-480.
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Task Force Members, Celia Oakley, Anne
ild, Bernard Iung, Patricia Presbitero,
et al. Expert consensus document on
management of cardiovascular diseases
The task force on the
management of cardiovascular diseases
during pregnancy of the European
Society of Cardiology. Eur Heart J, 2003;
Bonow RO, Carabello BA, Kanu C, et al.
ACC/AHA 2006 guidelines for the
management of patients with valvular
heart disease: a report of the American
College of Cardiology/American Heart
Association Task Force on Practice
writing committee to revise
the 1998 Guidelines for the
Management of Patients With Valvular
Heart Disease): developed in
collaboration with the Society of
Cardiovascular Anesthesiologists:
endorsed by the Society for
Cardiovascular Angiography and
ntions and the Society of
Thoracic Surgeons. Circulation, 2006;
Mazghar, et al. Maternal cardiac
complications in women with cardiac
diseases. J Coll. Phy Surg Part I, 2005;
Cardiac diseases with pregnancy
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Chart – 1: Distribution according to risk classification
Chart – 2: Distribution according to NYHA
LOW RISK
MMR: <1%
MODERATE RISK
MMR: 5-15%
HIGH RISK
MMR: 25-50%
0
5
10
15
20
25
NYHA I NYHA II
diseases with pregnancy
International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.
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istribution according to risk classification.
Distribution according to NYHA grading [4].
• 31 CASES
• 19 CASES
• 9 CASES
NYHA II NYHA III NYHA IV
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Cardiac diseases with pregnancy
International Archives of Integrated Medicine, Vol.
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Chart – 3: Pregnancy outcome in each case
Chart – 4: Pregnancy outcome.
0
5
10
15
20
25
30
35
VAGINAL LSCS
35
6
2
EL LSCS
7 CASES
EM LSCS
9 CASES
diseases with pregnancy
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regnancy outcome in each case.
LSCS MTP
11
53
MTP
3%
43 CASES
NORMAL
69%
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NORMAL
OPERATIVE
VBAC
OBSTETRIC
CARDIAC
SUCTION
Cardiac diseases with pregnancy
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Chart – 5: Obstetric complications
Chart – 6: Cardiac complications in course of pregnancy
0
2
4
6
EPISIO
HEMATOMA, 1
0
2
4
6
8
2
diseases with pregnancy
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bstetric complications.
ardiac complications in course of pregnancy.
EPISIO
HEMATOMA, 1
PPH, 4
BLOOD
TRANSFUSION, 6
8
2
3
2
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2
Cardiac diseases with pregnancy
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Chart – 7: Maturity of newborn infants
Chart – 8: Distribution of birth weight of neonates
19%
60.70%
diseases with pregnancy
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aturity of newborn infants.
istribution of birth weight of neonates.
81%full term delivery
pre-term delivery
2.10%
11.80%
10%
16.90%
<1 kg
1.1 to 1.5 kg
1.6 to 2 kg
2.1 to 2.5 kg
> 2.5 kg
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Cardiac diseases with pregnancy
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Chart – 9: Perinatal outcome.
Source of support: Nil
02468
101214
9
diseases with pregnancy
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Nil Conflict of interest:
13
2 2
6
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Conflict of interest: None declared.
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