Objective: Maternal cardiac disease is one of the leading causes of non-obstetric maternal deaths in both developed,and developing countries. This study evaluated the pregnancies complicated by maternal cardiac diseases and presented the maternal, and fetal outcomes.
Methods: A total of 84 pregnant women with the diagnosis of maternal cardiac disease was included. The data was collected retrospectively through a period of 4-years. Demographic characteristics and clinical data of the patients were recorded from the reliable hospital database. Pregnancy outcomes were interpreted according to the type of the cardiac disease, and status of the patients which defined through New York Heart Association (NYHA) classification.
Results: The participants had the mean age of 27.87±5.43, and body mass index of 26.97±2.86. The median gestational week was 38.6 (35-41). N=31 (36.9%) were term pregnancies. Preterm rupture of membranes was detected at 11 (13.1%). The mostly observed cardiac abnormality was rheumatic cardiac disease with isolated mitral stenosis (n=49). In addition, 8 (9.5%) had arrythmia, 6 (7.1%) had acute rheumatic fever, 7 (8.3%) had mitral valve prolapse, 5 (6%) had mitral stenosis, 1 (1.2%) had pulmonary hypertension. Nine women (8.18%) had the history of surgical correction of cardiac disease prior to pregnancy. The route of delivery was vaginal in 29(35%) women. C-section was applied for 55(66%). The primary C-section rate was 58% (n=40). Endocarditis prophylaxis was applied for 34(40.5%). At postpartum, cardiac complications were noted in 20 (18.2%) women, out of which 12 had pulmonary edema. Maternal mortality rate was 3.6% (n=4), 3 of which were due to pulmonary edema. The distribution of the patients according to the NYHA functional classification were 55.6, 36.1 and 8.3% for NYHA classes I-II and IIIIV, respectively. The birth weight was 3.194±507 grams, and small for gestational age was observed at 48 (46.3%) births. The 7 of the pregnancies were concluded with still birth (6.8%) and neonatal death was seen in 3 newborns (2.9%). APGAR scores at 1st and 5th minutes were 7(2-8) and 9(7-10), respectively. Congenital cardiac disease was not detected at any newborn. Neonatal intensive care unit was needed for 8 neonates (9.5%). There was no significant difference in birth weight, gestational age at delivery, and perinatal morbidity rate between the NYHA stage III and stage IIIIV groups (p >0.05), whereas maternal morbidity and cesarean delivery rates were significantly higher in the NYHA stage IIIIV group (p <0.001).
Conclusion: Consistent with the literature, rheumatic cardiac disease is the predominant cardiac problem in the current study. Most of the women were at good functioning group. Besides, maternal morbidity and C-section rates were significantly increased by the increasing NYHA stage. Even the pregnancy is a physiological event, it puts a burden on the cardiovascular system which may lead to aggravation of the cardiac diseases. Therefore, pregnant women with cardiac disease should receive an elaborate antenatal care to reduce the risk of maternal, and fetal morbidities and mortality.
Anahtar Kelimeler: High risk pregnancy, Maternal cardiac disease, Maternal mortality, Morbidity, Perinatal outcomes