A CLINICAL STUDY OF HEART DISEASE IN PREGNANCY AT GOVERNMENT MATERNITY HOSPITAL
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 45
Abstract
BACKGROUND 1Heart disease is the fourth most common cause of maternal death and the most common indirect cause of maternal mortality. The physiological adaptation of normal pregnancy can induce symptoms and alter clinical findings that may confound the diagnosis of heart disease. The obstetrician providing care for pregnant women with heart disease is now faced with different spectrum of heart diseases compared with her counterparts two to three decades earlier.2 Women with severe heart disease will benefit immensely from counselling before deciding to become pregnant. 3 There is decrease in the frequency of rheumatic fever and its related heart disease concomitant with the improvement in medical and surgical therapy. Due to industrialisation and changing cultural trends, incidence of ischemic heart disease is slowly increasing in women of reproductive age groups. We conducted a study to evaluate the influence of biological factors like age, gravidity, duration of pregnancy and mode of labour when pregnancy is complicated by heart disease and to study the changing trends in the types of heart disease, clinical presentation, investigations, management and outcomes in cases of heart disease complicating pregnancy. The onset of an attack of acute rheumatism superimposed upon a damaged heart during pregnancy is a serious condition. Study Objectives1. To evaluate the influence of biological factors like age, gravidity, duration of pregnancy and mode of labour when pregnancy is complicated by heart disease. 2. To study the changing trends in the types of heart disease, clinical presentation, investigations, management and outcomes in cases of heart disease complicating pregnancy. 4 MATERIALS AND METHODS In this Descriptive study, we studied 50 cases of heart disease complicating pregnancy and followed them from antenatal outpatient department. 2D echo with Doppler study was used as a confirmatory investigation. The cases were classified as proposed by revised New York Heart Association i.e. the aetiological diagnosis, anatomical diagnosis, physiological classification, cardiac status or functional classification and therapeutic classification or prognosis. Functional class 1 patients were advised to have regular antenatal check-ups while functional class 3 & 4 patients were admitted as soon as they reported. No diagnostic or therapeutic interventions were withheld for optimal maternal safety. RESULTS We studied 50 cases of heart disease complicating pregnancy during the study period. Incidence of cardiac disease was found to be 0.42% in the present study. Most of the study population were in the age group of 21-25 years. About 90% of the cases in this study were belonging to low socio-economic status. Most of the patients were multi gravidas (66%). 70% patients had chronic rheumatic heart disease. Mitral valve was involved in all cases except in a case of pure TR. As the age and gravidity increased the functional grade seemed to be increasing in this study. Single maternal death occurred in this study and belonged to class 4. 24% of cases had anaemia with Hb less than 10 gm/dl. 22% patients had pregnancy induced hypertension. Maximum number of cardiac failures were noted during intrapartum period and immediate postpartum period. 50% of patients had spontaneous vaginal delivery. 14% needed an assistance with outlet forceps. Caesarean section was done in 20% of patients purely for obstetrical reasons. Most common presentation is vertex. Birthweight over 2.5 kg is seen in about 58.5% cases. One still birth in this study was due to rupture uterus. CONCLUSION 50% patients with heart disease in pregnancy were reviewed for the period August 2017-2018. Incidence of heart disease is found to be 0.42%. Incidence of rheumatic heart disease has decreased, and the incidence of congenital heart diseases has increased. Maximum number of cases was seen in 21-25 years age group. But it is found that there is a percentage increase of the cases in 16- 20 years age group, which can be attributed to increased incidence of congenital heart disease in this study. Age and gravidity were found to correlate with the functional class of heart disease. Most of the study cases were from a low socio-economic group and from urban slums. Most of them had vaginal deliveries and 20% had LSCS for obstetrical indications. The incidence of LSCS is noted to be rising. Duration of labour both in primigravidas and multigravidas was found to be decreased when compared with the previous studies. There is a decreased incidence in the preterm babies and babies weighing less than 2 Kgs, compared to 1992 study at GMH. Perinatal mortality was 23.25/1000 births. Pregnancy outcome greatly varies when the pregnant cardiac is booked case and when she is constantly looked after by a cardiologist & obstetrician with a touch of personal care.
Authors and Affiliations
Geddam Swarupa, Korra Damayanthi, Nalla Kavya, Naaz Fathima, K. Sindu, Manorama Manorama, Aggu Vanitha
Keywords
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- EP ID EP550459
- DOI 10.14260/jemds/2018/1095
- Views 99
- Downloads 0
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