title: Cardiac disease in pregnancy.
abstract: OBJECTIVE
  To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country.
  
  
  METHODS
  A retrospective analysis was carried out of 207 pregnancies in women with cardiac disease who delivered at >or=28 weeks of gestation from June 1994 through December 2000 at a tertiary care center.
  
  
  RESULTS
  Rheumatic heart disease (n=183, 88%) with isolated mitral stenosis (n=71) was the predominant cardiac problem. Septal defects were the most common form of congenital heart disease (n=24). In 28 (13.52%) women, the diagnosis of cardiac disease was made during pregnancy. Cardiac complications were noted in 62 (29.95%) and fetal complications in 42 (20.28%) pregnancies. Patients in NYHA class I/II (n=175, 84.54%) had fewer maternal complications and their babies had a higher birth weight than those in NYHA class III/IV (n=32, 15.45%). Cardiac intervention was performed prior to pregnancy in 111 (60.65%) patients with rheumatic heart disease: PTMC/CMV in 73 and valve replacement (VR) in 38. Maternal and fetal outcome was better in patients with prosthetic valves (n=38) and the majority (97.4%) of them remained in NYHA class I/II. Cardiac intervention was safely carried out during pregnancy in 10 women (PTMC in 7, CMV in l, and VR in 2). One of them developed congestive cardiac failure during labor. None of the newborns of the 41 women who had received anticoagulants had any congenital malformation.
  
  
  CONCLUSIONS
  Rheumatic heart disease was the predominant type. Patients in NYHA class I/II had a better maternal and fetal outcome than those in NYHA class III/IV. Surgical correction of the cardiac lesion prior to pregnancy was associated with better pregnancy outcome. Pregnant women with prosthetic valves tolerated pregnancy well.
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India. neerjabhatla@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Bhatla
authors.forename: S
authors.initials: S
authors.lastname: Lal
authors.forename: G
authors.initials: G
authors.lastname: Behera
authors.forename: A
authors.initials: A
authors.lastname: Kriplani
authors.forename: S
authors.initials: S
authors.lastname: Mittal
authors.forename: N
authors.initials: N
authors.lastname: Agarwal
authors.forename: K K
authors.initials: KK
authors.lastname: Talwar
mesh_terms: D000293:Adolescent; D000328:Adult; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D007194:India / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D002317:Cardiovascular Agents