Outcome of pregnancy among parturients complicated with heart disease in Rajavithi Hospital.

ABSTRACT

OBJECTIVE: To compare the maternal and perinatal outcomes at Rajavithi Hospital from January 1st, 2000 to December 31st, 2004, (5 years), (3rd period) with those occurring in the previous two periods1st and 2nd (1965-1970, (6 years) and 1985-1990, (6 years) respectively. MATERIAL AND METHOD: Retrospective analysis of various medical records of 196 cases diagnosed pregnancy with heart disease. RESULTS: The prevalence of parturients complicated with heart disease was 0.41%, an increase of 2 and 5 times compared with the first and second period, respectively. Congenital heart disease was the most common type of disorder in the second and third period (64.28% and, 49.49%, respectively) while rheumatic heart disease was the most common disorder in the first period (54.86%). Most of the cases in the 2nd and 3rd periods were delivered by operative vaginal delivery (46.43% and 44.90%, respectively), while spontaneous vaginal delivery was the most common mode of delivery in the first period (78.99%). All of the postpartum and perinatal complications except postpartum hemorrhage were significantly higher in the worse class of NYHA (class III/IV) than those in the better class of NYHA (class I/II). The maternal death rate in the third period increased 1.81 times and 13.66 times compared with those in the first and second periods, respectively. CONCLUSION: Congenital heart disease was the most common heart disease in pregnancy from 1985 to 1990 and 2000 to 2004. Patients in the NYHA class III/IV had worse maternal and fetal outcomes than those in the NYHA class I/II except for postpartum hemorrhage. Maternal mortality rate was highest from 2000 to 2004 (12.57 per 100,000 live births).