Feto-maternal outcomes in women with congenital heart disease

ABSTRACT

To determine Pregnancy Outcomes in Women with Congenital Heart Disease. Cross sectional study. This study was conducated at Obstetrics and Gynaecology ward 9 Jinah Postgraduate Medical Centre Karachi and National Institute of Cardiovascular Diseases [NICVD], from May 2008 and January 2011. All Pregnant women with congenital heart disease presenting at OPD of National Institute of Cardiovascular Diseases delivering at Obstetrics and Gynaecology ward 9 Jinah Postgraduate Medical Centre Karachi were included. Cardiac complications were subdivided into primary and secondary Cardiac events. A primary cardiac event consisted of cardiac death, cardiac arrest, stroke, symptomatic sustained bradyarrhythmia or tachyarrhythmia requiring therapy, or pulmonary edema documented by physical examination or radiography. Decline in >/= 2 NYHA functional classes, need for urgent invasive cardiac interventions during pregnancy or within 6 weeks postpartum, and symptomatic nonsustained bradyarrhythmia or tachyarrhythmia requiring therapy were considered secondary cardiac events. Obstetric events consisted of preeclampsia, postpartum hemorrhage, and noncardiac death. Neonatal events were defined as preterm delivery [<37 weeks of gestation], birth weight small for gestational age respiratory distress syndrome, cerebral intraventricular hemorrhage, fetal death or neonatal death. Spontaneous abortion was defined as fetal loss before 20 weeks of gestation. 36 women with congenital heart disease. Spontaneous abortions occurred in 6 pregnancies at 10.8 +/- 3.7 weeks, and 2 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.6% and sustained arrhythmias in 8.3%. Adverse neonatal outcomes occurred in 27.7% of ongoing pregnancies and included preterm delivery [19.4%], small for gestational age [8.33%], respiratory distress syndrome [833%], intrauterine fetal demise [2.77%], and neonatal death [2.77%]. Feto-maternal outcome in women with congenital heart disease can be improved further with proper management and counseling