Dhivya, Sethuraman (2008) Maternal and fetal outcomes in rheumatic heart disease in pregnancy. Masters thesis, Madras Medial College, Chennai.
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Abstract
AIMS OF THE STUDY: 1. To study the maternal and fetal outcomes in pregnancies complicated by rheumatic heart disease in our institution over a period of one year. 2. To analyse possible prognostic factors that would enable us to formulate necessary guidelines for safe motherhood. 3. To analyse outcomes in surgically corrected heart disease. MATERIALS AND METHODS: TYPE OF STUDY - Prospective study. MATERIALS: This study was conducted in The Institute of Obstetrics and Gynecology, Egmore, Chennai. One hundred and twenty nine (129) women with rheumatic heart disease were registered in this study from January 2006 to December 2006. Inclusion Criteria - All patients with Rheumatic heart disease (MS, MR, AR, AS: as diagnosed from history, clinical examination and echocardiography) who were • On long term treatment, • Newly diagnosed, • Surgically operated on, • And in need of medical termination and sterilization were included for the study. Exclusion Criteria - Patients with • Mitral valve prolapse with mitral regurgitation, • Isolated aortic stenosis, • Congenital heart disease. METHOD: All patients having RHD, outpatients, inpatients and those admitted via our emergency department were meticulously followed up antenatally as well as from admission till discharge. The clinical course during pregnancy and the maternal, foetal outcomes were studied. SUMMARY: In this study of 129 pregnant women with RHD : · The incidence of heart disease was 0.96% for all deliveries during our study period. · The incidence of RHD was 71.6% · 65.1% of women gave a h\o rheumatic fever · 45(34.9%) patients had undergone surgical correction and 84(65.1%) did not undergo surgical correction. · The most common surgical procedure done was closed mitral commisurotomy(80%). · The most common valvular lesion was mitral stenosis(48.1%). · 90.8% of patients belonged to class IV\V socioeconomic status. · 86.6% of patients were between 21-28 years age. · 95.3% had moderate to severe disease but only 18.6% were in NYHA class III/IV. Hence severity of disease did not correlate with NHYA class. · 76.7% of women had vaginal delivery. LSCS was done for obstetric reasons alone. · There were more preterm births and low birth weight babies in the not-operated group. · There was no significant difference in the incidence of CCF between both groups. · Women with mechanical valves had good maternal and fetal outcomes. · Only 40.2% of women adopted some form of contraception. CONCLUSION: According to this study, pregnant women with mitral stenosis still are at relatively high risk of experiencing maternal complications. The results shown are consistent with those reported by other studies. The association of the pre pregnancy functional class with the risk of maternal events raises attention to the possibility of reducing these complications in pregnant women with mitral stenosis by means of early interventions aimed at improving their functional class. The mitral valve area was also strongly significantly associated with the risk of maternal events. If the mitral valve area was the only determining risk factor for events in these patients, the correction of high-degree stenosis should correspond to a pronounced reduction of the occurrence of maternal complications during pregnancy and puerperium. Based on this assumption and with the purpose of reducing the gestational risks, interventional treatment (balloon mitral valvuloplasty or surgery) prior to conception has been recommended to patients with severe mitral stenosis who wish to get pregnant. However, like in the present study, usually women with mitral stenosis are referred for cardiological follow-up only after the beginning of pregnancy. Taking these facts and the low incidence of complications observed when the balloon mitral valvuloplasty is done during pregnancy this procedure should be seriously considered for all types of valve area, independently of their functional class, particularly if we take into account that acute lung edema can be the first clinical manifestation of mitral stenosis during pregnancy .
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Maternal ; fetal outcomes ; rheumatic heart disease ; pregnancy. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Nov 2017 03:03 |
| Last Modified: | 09 Dec 2017 03:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4122 |
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