Maternal cardiac diseases complicating pregnancy: a review of 105 cases

Abstract

The outcome of pregnancies in 105 patients with heart diseases in TUTH, Kathmandu, Nepal between April 1995 and May 2001 was reviewed. The incidence of heart disease was 0.55% of the total 19038 deliveries. Rheumatic (79), congenital (17) and miscellaneous groups (9) complicated the pregnancy.
Significant number (53) had their diagnosis made at the index pregnancy. Patients
who developed cardiac failure (17) mostly did during antenatal period (20-42 weeks); the majority had cardiac failure (14) at third trimester. Two of the cases that had cardiac failure at 33 weeks ultimately had stillbirths later at term. Induction of labour for such cases, which was discouraged earlier, should be considered.
In our hospital labour analgesia with epidural anaesthesia, pethidine or morphine is not a routine practice. Injection Methergin is also generally withheld. Save one or two, most Cesaerean sections had obstetrical indication. Prophylactic forceps or ventouse were barely used.
There were two maternal deaths. One of them had pregnancy complication as
eclampsia and presented with SVT and MI at 34 weeks. The other case died within 48
hours of Caesarean delivery for critical mitral stenosis with pulmonary hypertension.
The perinatal losses were 7.
This article strongly emphasizes the need for routine cardiac evaluation of patients
at their very first antenatal check up so that patie nts with cardiac disease can benefit
from shared co-operation between cardiologist, cardiothoracic surgeon, anaesthelogist
and obstetrician.