[Pregnancy outcome in women with rheumatic heart disease].
OBJECTIVE
To evaluate the pregnancy outcome of women with rheumatic heart disease.


METHODS
Clinical data of 65 cases of pregnant women with rheumatic heart disease from Jan 1993 to July 2006 were analyzed. They were divided into four groups according to the degree of mitral stenosis: normal group (> 4.0 cm(2)), slight group (2.5 - 4.0 cm(2)), moderate group (1.5 - 2.5 cm(2)) and severe group (< 1.5 cm(2)); four groups according to the degree of pulmonary hypertension: normal group, slight group (pulmonary hypertension ranging from 31 to 49 mm Hg, 1 mm Hg = 0.133 kPa) moderate group (from 50 to 79 mm Hg) and severe group (equal to and more than 80 mm Hg); two groups according to heart operation: non-operated group and operated group; and four groups according to the degree of New York heart association (NYHA) class. The perinatal mortality and morbidity of mothers and fetus were analysed.


RESULTS
(1) The rate of NYHA class IV was 80% (12/15 cases) in moderate-severe group of mitral stenosis and the rate of NYHA class I and II was 80% (16/20 cases) in normal group, with a significant difference between them (P < 0.05). (2) The rate of NYHA class I and II was 73% (24/33 cases) in group of normal pulmonary pressure and the rate of NYHA class IV was 6/7 in severe group of pulmonary hypertension (P < 0.05). (3) The rate of NYHA class I and II was 71% (10/14), and NYHA class III or IV was 14% (2/14) in heart operated women (P < 0.05). (4) The delivery week was 34.6 and the birth weight was 2176 g averagely in NYHA class IV group and had significant differences from NYHA class I group (P < 0.05). There were 9 cases of abortion medically (18.9%, 9/65), 18 of preterm labor medically (28%, 18/65), 4 of fetal growth restriction (FGR) (6%, 4/65) and 3 of perinatal mortality (5%, 3/65), which all happened in groups of NYHA class III and IV. (5) The rate of NYHA class III and IV was 6/7 in atrial fibrillation women.


CONCLUSIONS
Pregnant women with rheumatic heart disease of moderate-severe mitral stenosis, severe pulmonary hypertension and atrial fibrillation are at high risk of heart failure. The fetal outcome is not good in cases of NYHA class III and IV.
Department of Obstetrics and Gynecology, Affiliated Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Jian-Hua
JH
Lin
Wan-Wen
WW
Ling
A-Juan
AJ
Liang
D000328:Adult; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D007231:Infant, Newborn; D008946:Mitral Valve Stenosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology / Q000503:physiopathology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D012720:Severity of Illness Index