Fetomaternal outcome in pregnancy with cardiac disease.

OBJECTIVE To determine fetal and maternal outcomes in women presenting with heart disease during pregnancy and labor. DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Gynae/Obstetrics, MCH, Center, Unit II, PIMS, Islamabad, during a period of 2 years from March 2001 to February 2003. PATIENTS AND METHODS Forty-two pregnant women with heart disease delivered at MCH Center, Unit II, during the study period were included. Maternal outcome measures included obstetric and medical complications and maternal mortality while fetal outcome measures were prematurity, intrauterine growth restriction and perinatal mortality, intrauterine death and indicated terminations of pregnancy. RESULTS The mean age was 27.50 -/+ 5.17 years (standard deviation). Of the 42 women, 33 (78.6%) were booked for antenatal care and 9 (21.4%) were non-booked. Congenital heart disease was present in 7 (16.7%) while 28 (65.3%) had rheumatic heart disease and mitral valve disease was the commonest. Among the remaining 7 women with acquired heart disease, 3 (7.1%) women had ischemic heart diseases (IHD), 1 (2.4%) had primary pulmonary hypertension, 2 (4.8%) patients had peripartum cardiomyopathy and 1 (2.4%) had aortic dissection. Based on New York Heart Association Functional classification (NYHA) 16 (38.1%) patients were asymptomatic (class I) and 3 (7.1%) in class IV. Thirty-two (76.2%) achieved spontaneous vertex delivery (SVD), LSCS was performed in 4 (9.5%) women, 2 (4.8%) women had spontaneous expulsions of dead fetus and 2 (4.8%) had suction and curettage for therapeutic termination of pregnancy on medical grounds. Obstetric complications occurred in 17 (40.4%) women, 5 (11.9%) had medical complications and 3 (7.1%) maternal mortalities occurred. Regarding fetal outcome, 6 (14.3%) infants had intrauterine growth restriction (IUGR), 2 (4.8%) perinatal deaths occurred due to prematurity while there was 1 (2.4%) intrauterine death. Indicated terminations of pregnancy were done for 4 gestations (7.1%). Low birth weight was noted in 12 (28.6%) infants. CONCLUSION Heart disease with pregnancy is a very high risk condition and maternal mortality ratio (MMR) was 7142/100,000 births. The management of these cases should be multidisciplinary to optimize care for these patients and large families be strongly discouraged.