Evaluation of fetomaternal outcome in pregnancies complicated by heart disease: our experience at a tertiary care centre

Background: Heart disease is an important cause of indirect maternal deaths accounting for 20% of all cases, complicating approximately 1% of all pregnancies. During pregnancy, increased cardiac demands potentially increase morbidity and mortality in women with underlying heart disease. This study illustrates the fetomaternal outcome in pregnancies complicated by heart disease.Methods: This study is a prospective observational study which was carried out from December 2013 to August 2015 at a tertiary care teaching hospital of armed forces India. A total of forty four pregnant women with heart disease were attended during the study period. Various parameters were used to measure maternal outcome like preterm labour, cesarean delivery, congestive cardiac failure, maternal mortality, while fetal outcome was measured in terms of low birth weight, prematurity, intrauterine growth restriction, perinatal mortality and intrauterine death.Results: A total of 7545 pregnant women delivered during the study period, of which 94 were patients with heart disease giving a prevalence of 1.2%. Acquired valvular heart lesions were found in 61 patients (64.9%) with mitral valve being the commonest valve affected in 69 patients (73.4%), others were congenital. Of the group, 89 patients were in NYHA class I and 05 in NYHA class II. Majority, 44 patients (46.8%) delivered vaginally while 31 patients (33%) underwent a cesarean delivery and 30 babies (31.9%) were low birth weight. There was no neonatal mortality. Maternal mortality was low (1.1%), while 43 (45.7%) had obstetric complications.Conclusions: Multidisciplinary team approach involving obstetrician, neonatologist, cardiologist and anesthesiologist led to the favorable outcome in our study. Key determinant of adverse fetomaternal outcome was the poor functional class of NYHA