A Prospective Observational Study of Heart Diseases in Pregnancy and Fetomaternal Outcomes.

Objectives: To determine the heart diseases during pregnancy the maternal and perinatal outcomes.

Methods: This prospective observational study was conducted in a tertiary care hospital on 22,360 antenatal women registered to department of Obstetrics and Gynecology. The data recorded included demographic, clinical and obstetric characteristics, nature of the underlying cardiac lesions, and functional class. ECG and echocardiography were done to know the type and severity of cardiac lesions. Fetomaternal outcomes were assessed at follow-up clinical visits during second, third trimester, peripartum period, and at 6 weeks postpartum.

Results: Heart diseases were present in 50(0.2%) women. Congenital heart diseases were present in 16(32%) patients, with most common being ventricular septal defect (VSD) in 7(14%) patients. Rheumatic heart diseases were present in 15(30%) patients, with most common being first degree heart block [4(8%)]. Mode of delivery was lower segment cesarean section in 32(64%) women and medical termination of pregnancy in 1(2%) patient. Postpartum complications were seen in 14(28%) patients; the most common being congestive cardiac failure in 5(10%) patients. Fetal complications were present in 21(42%) neonates which comprised of neonatal intensive care unit admission [13(26%)], intrauterine growth restriction in 7(14%), low birth weight in 6(12%), preterm in 5(10%), meconium aspiration syndrome in 4(8%) and intrauterine death in 3(4%) cases.

Conclusion: To conclude, heart diseases are present in 0.2% pregnant women with VSD rheumatic heart diseases being the commonest. Pregnant women with cardiac disease experience cardiac, obstetric, and fetal complications. Thus, cardiac diseases must be diagnosed to lower perinatal morbidity and death.