title: Pregnancy complicated by maternal heart disease: a review of 281 women.
abstract: OBJECTIVE
  To study maternal heart disease in an Indian setting for: (1) different etiological factors, (2) different types of lesions, and (3) maternal and perinatal outcome.
  
  
  METHODS
  281 women with heart disease who delivered ≥28 weeks of gestation at different teaching institutions (tertiary care centres) in India were studied.
  
  
  RESULTS
  Rheumatic heart disease (n = 195; 69.4 %) with isolated mitral stenosis (n = 75; 26.7 %) were the commonest. Septal defect (n = 27; 9.6 %) was the predominant lesion among the congenital heart disease (n = 60; 21.3 %) patients, whereas in the miscellaneous group (n = 26; 9.2 %), ischemic heart disease (n = 10; 3.6 %) was the leading cause. Multiple cardiac lesions were also diagnosed in 100 (35.58 %) women. In 87 (31 %) women, diagnosis was made first time in labor. Majority n = 131, (46.6 %) had spontaneous vaginal delivery and few (n = 9; 3.3 %) required induction of labor. Cardiac complications were noted in 72 women (25.6 %). There were three (1.06 %) maternal deaths and perinatal mortality was 4 % (n = 11).
  
  
  CONCLUSIONS
  In this study, rheumatic heart disease in pregnancy is still predominant though acquired cardiac lesions are rising. In rheumatic heart disease, mitral valve involvement was the commonest and multiple valve lesions were a major observation. Most common obstetric complication was small for gestation baby. Maternal morbidities in the unbooked women are high and congestive cardiac failure was the major cardiac complication.
authors.affiliation: Department of Obstetrics & Gynaecology, Midnapore Medical College & Hospital, CD 55, Salt Lake City, Kolkata, 700 064 India.
authors.forename: Hiralal
authors.initials: H
authors.lastname: Konar
authors.forename: Snehamay
authors.initials: S
authors.lastname: Chaudhuri
keywords: Heart disease; Outcome; Pregnancy; Types