RESUMO
Background@#Cardiac disease increases morbidity and mortality in pregnant patients. This is found in both developing countries and underdeveloped countries. Cardiovascular demand increases with pregnancy, causing additional stress on a diseased heart. This then poses a greater risk of complications; thus, specialized care involving an Obstetric-Gynecologist and a Cardiologist is warranted. The Modified WHO Classification of Maternal Cardiovascular Risk, CARPREG, and CARPREG II predict risk among gravidocardiac patients and corresponding needed medical attention perinatally. Little data has been known on the clinical outcomes of pregnancy among gravidocardiac patients in the Philippines. This study aims to gauge the clinical outcomes of gravidocardiac patients admitted to a tertiary hospital in Dumaguete City.@*Methods@#A retrospective, cross-sectional descriptive study was carried out among all gravidocardiac patients admitted for labor and delivery between January 2015 and December 2019. A chart review of the cases satisfying the inclusion criteria was done. Data gathered were tabulated, and a Chi-Square was used to assess if there was a significant relationship between the cardiac condition and the mode of delivery, duration of pregnancy, maternal outcomes, and fetal outcomes.@*Results@#Cardiac lesions noted among gravidocardiac patients include mitral valve prolapse, which comprised the majority of cases, patent ductus arteriosus, ventricular septal defect, mitral valve regurgitation, aortic valve regurgitation, atrial septal defect, and peripartum cardiomyopathy. Pregnancies were mainly carried to term with vaginal delivery as the primary mode of birth. Maternal outcomes were generally favorable, with no deaths recorded. Fetal outcomes were variable among cases, and fetal mortality was recorded at 3.92%. A significant relationship was seen between maternal cardiac condition and maternal outcomes of the pregnancies.@*Conclusion@#Among pregnant patients with cardiac conditions, maternal outcomes of pregnancy can be predicted in association with the cardiac condition. There is a great need to educate the public on the need for proper perinatal care when a cardiac condition in pregnancy is detected.
RESUMO
Resumen Se presenta el caso de una gestante con cardiopatía congénita no estudiada que acudió al servicio de urgencias en la semana 25 + 4 por palpitaciones, con evidencia de hipertensión arterial desde el ingreso. Los estudios diagnósticos revelaron anomalía de Ebstein, con gran compromiso de cavidades derechas y asociado a comunicación interauricular. También se documentó preeclampsia lejos del término, con restricción grave del crecimiento intrauterino. Durante la estancia hospitalaria, y ante negativa de la paciente a finalizar la gestación, desarrolló síntomas de congestión pulmonar por sobrecarga. Una vez falleció el feto in utero y después de inducir el parto, remitieron los síntomas cardiovasculares y se controló la hipertensión.
Abstract We present the case of a pregnant woman with previously undiagnosed congenital heart disease, who presented to the emergency department at week 25 + 4 due to palpitations, with evidence of arterial hypertension from admission. Diagnostic studies revealed Ebsteins anomaly, with great involvement of the right cavities and associated with atrial septal defect. Preeclampsia was also documented far from term, associated with severe intrauterine growth restriction. During the hospital stay and due to the refusal of the patient to end the pregnancy, she developed symptoms of pulmonary congestion due to overload, once the fetus died in utero and after inducing labor, the cardiovascular symptoms remitted and hypertension was controlled.