Maternal and perinatal outcome in heart disease complicating pregnancy

Background: Congenital as well as acquired heart diseases remain one of the important factors complicating pregnancy and remains a significant cause of maternal as well as perinatal morbidity and mortality. Pregnant women with cardiac diseases need a comprehensive management strategy to minimize the adverse effect of cardiac conditions on pregnancy and its outcome.Methods: This was an observational study conducted in a tertiary care hospital located in an urban area. Pregnant patients diagnosed to be having congenital or acquired heart diseases and admitted either in ward, labour room or intensive care unit were included in this study on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all the cases. Patients were classified according to New York Heart Association. Maternal and perinatal Outcome was studied in cases.Results: The incidence of cardiac disease amongst pregnant patients during study period was found to be 0.58%. The mean age of studied cases was found to be 23.16±5.06 years. Most of the patients were primigravida (85.71%) and 6 patients (14.29%) were multigravida. The majority of the patients (76.19%) belonged to NYHA grade I whereas 8 (19.05%) patients belonged to NYHA class II. 1 patient belonged to NYHA Class III and Class IV respectively. Isolated mitral stenosis secondary to rheumatic valvular involvement was the single most common lesion seen in studied cases and was seen in 8 (19.05%) patients. Ventricular septal defect was most common congenital heart disease (14.28%). 26 (61.90 %) delivered by normal vaginal delivery whereas emergency and elective LSCS was done in 9 (21.43%) and 6 (14.29%) patients respectively. nature of cardiac disease was common factor for elective cesarean section which was done in 5 cases (11.90%). Postpartum cardiac failure (14.29%) and postpartum hemorrhage (9.52%) were common maternal complications. 24 (57.14%) neonates required admission in neonatal intensive care unit. The most common indication for NICU admission was found to be low birth weight (23.81%) followed by birth asphyxia (19.05%).Conclusions: Cardiac disease in pregnancy is associated with increased risk of maternal as well as perinatal morbidity and mortality. Early diagnosis and management during pregnancy is essential to reduce maternal as well as perinatal outcome in these cases