Cardiac disease in pregnancy--maternal and perinatal outcome.

To assess the maternal and perinatal outcome in pregnant women with cardiac disease, a prospective study was carried out among 51 pregnant women with cardiac disease between January 2006 and August 2008 at a tertiary care centre at BJ Medical College, Ahmedabad, Gujarat. Rheumatic cardiac disease (68.62%) with mitral valve involvement (88.57%) was the commonest cardiac disease. In congenital cardiac disease (21.57%) group septal defect was found as the predominant form. Cardiac surgeries were performed in 11 women before pregnancy out of which 7 had balloon valvotomies, 3 had valve replacements and one had corrective tetrology of Fallot surgery. Two valvotomies were safely done during pregnancy. Out of 51 total patients, two women had opted for termination and two were lost to follow-up. Cardiac complications developed in 17.02% of the women, most common being congestive cardiac failure. It was found more in New York Heart Association grades III and IV (p = 0.00001). A total of 68.08% women delivered vaginally and 31.91% delivered by caesarean section. Complication rate was high (33.33%) in caesarean section group (p = 0.05). Maternal and perinatal outcome was good in general with no maternal death and three perinatal deaths. There were more preterm babies (27.7%; p = 0.03) and babies with intra-uterine growth restriction (48.9%; p = 0.65). None of the newborns of the women who had received anticoagulants had any congenital malformation. Rheumatic heart disease still constitutes the major type of heart disease in our country. Maternal and perinatal morbidity increases with increase in New York Heart Association grade. Surgically treated women tolerate pregnancy well. Vaginal delivery is safer and caesarean section should be reserved only for obstetric indications. Maternal and perinatal outcome can be improved by team approach at tertiary care centre.

Vaginal birth after one caesarean section: analysis of indicators of success.

A study was carried out among 81 women with previous one caesarean section (CS) done for non-recurrent indications to confirm the efficacy and safety of trial of labour (TOL) and to examine the effect of various factors on the mode of delivery. Singleton term pregnancy, vertex presentation and adequate pelvic capacity were the pre-requisites for case selection. Careful monitoring was done during labour and effect of various factors on the outcome was analysed statistically. Success rate of TOL was 73%. A non-recurrent indication for previous CS, such as malpresentation and foetal distress is associated with higher success rate of vaginal birth after caesarean (VBAC) compared to recurrent indications, such as cephalopelvic disproportion (CPD) and failure to progress (FTP). Prior vaginal birth improves the success rate (87%) of VBAC. Factors like premature rupture of membranes, hypertensive disorders of pregnancy, and post-date pregnancy did not affect the outcome adversely. Rate of emergency CS was 44% in women with floating head foetus, 39% in induction/augmentation group and 43% when birth weight of the foetus was > 3000 g. No maternal/perinatal mortality observed. Maternal/perinatal morbidity was low in cases with successful TOL. Uterine rupture occurred in one woman. There are few absolute contra-indications to attempted VBAC. Though the success rate does vary with different pre-existing factors, the clinician may anticipate greater than 50% chance for success in any individual labour.