title: Severe heart disease complicating pregnancy does not preclude a favourable pregnancy outcome: 15 years' experience in a single centre.
abstract: Heart disease (HD) in pregnancy remains a major cause of non-obstetric maternal and neonatal mortality and morbidity. This study describes the outcome in 164 pregnant women with HD (158 deliveries in women in New York Heart Association (NYHA) Classes 1 and 2; 17 in NYHA Classes 3 and 4) who received good antenatal care and benefitted from a specific protocol and experience of a dedicated staff. There were no maternal or neonatal deaths; 46 women were diagnosed peripartum. Based on a sub-division into NYHA categories, and when sub-divided by HD, there were no statistically significant differences between groups with regard to maternal age, gestational age at admission or at delivery, birth weight, 5 min Apgar scores, mode of delivery (caesarean delivery), senior obstetric/anaesthesiology staff in attendance or delivery during day/working hours. There was a higher incidence of pre-term deliveries in women with rheumatic heart disease and Marfan syndrome (p = 0.06) relative to others. Babies of women with coronary heart disease had prolonged postpartum course in the NICU (p = 0.0001) and longer total hospital stays for the mother. In conclusion, well-managed, motivated mothers with HD who benefit from comprehensive antenatal care, and are managed primarily by their obstetric and anaesthesia teams, can aspire to a good outcome for themselves and their babies.
authors.affiliation: Department Obstetrics and Gynecology, Hebrew University of Jerusalem, Shaare Zedek Medical Centre, Jerusalem, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Michaelson-Cohen
authors.forename: D
authors.initials: D
authors.lastname: Elstein
authors.forename: A
authors.initials: A
authors.lastname: Ioscovich
authors.forename: S
authors.initials: S
authors.lastname: Armon
authors.forename: M S
authors.initials: MS
authors.lastname: Schimmel
authors.forename: A
authors.initials: A
authors.lastname: Butnaru
authors.forename: A
authors.initials: A
authors.lastname: Samueloff
authors.forename: S
authors.initials: S
authors.lastname: Grisaru-Granovsky
mesh_terms: D000328:Adult; D001724:Birth Weight; D003327:Coronary Disease / Q000150:complications; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005865:Gestational Age; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008423:Maternal Age; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications