PMID- 36993019
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230331
IS  - 2249-4863 (Print)
IS  - 2278-7135 (Electronic)
IS  - 2249-4863 (Linking)
VI  - 11
IP  - 11
DP  - 2022 Nov
TI  - Maternal mortality and predictors of adverse outcome in patients with heart 
      disease in pregnancy.
PG  - 6752-6758
LID - 10.4103/jfmpc.jfmpc_1877_21 [doi]
AB  - INTRODUCTION: Heart disease in pregnancy possesses a great haemodynamic challenge 
      and is a known risk for increased maternal morbidity and mortality. The 
      functional status of the patient is one of the most significant parameters which 
      can impact the feto-maternal outcome. Many predictors have been studied and 
      compiled in various scoring systems time and again. The most updated and 
      validated is the modified WHO classification, according to which the presence of 
      pulmonary artery hypertension (PAH) and severe ventricular dysfunction (ejection 
      fraction <30%) mandates the patient to be under class IV, which along with 
      another important risk factor, i.e., New York heart association (NYHA) class, is 
      revaluated under the present study. The objective of this study is to examine 
      three of the most important predictors of adverse outcomes, i.e., functional 
      status (NYHA class), PAH, and left ventricular ejection fraction (LVEF) in 
      patients with heart disease in pregnancy. METHODS: It's a prospective study from 
      January 2016 to August 2017 wherein pregnant patients with heart disease were 
      divided on the basis of NYHA class, PAH, and LVEF, and the feto-maternal outcome 
      was recorded and evaluated in terms of maternal mortality, fetal demise, the 
      occurrence of major cardiac complication, and risk of preterm delivery. RESULTS: 
      A total of three out of 29 (10.34%) maternal deaths were attributed to a cardiac 
      cause. 5.45% of patients with heart disease had maternal mortality, which is in 
      contrast to the 1.12% maternal mortality rate in general at our centre. Three out 
      of 17 (17.64%) patients in NYHA classes 3 and 4 ended in maternal deaths, while 
      there were no mortalities in classes 1 and 2. Intrauterine fetal demise (23.52%), 
      risk of preterm delivery (relative risk = 0.4688; 95% CI: 0.2320 to 0.9470) was 
      significantly higher in patients belonging to NYHA classes 3 and 4 as compared to 
      those in classes 1 and 2. All of the ten (100%) patients who developed cardiac 
      complications belonged to classes 3 and 4. The percentage of abortions (20.00%), 
      intra uterine fetal demise (IUFD) (40.00%), and cardiac complication (80%) in 
      patients with LVEF <44% were significantly more than in patients with better 
      ejection fraction. Pulmonary artery systolic pressure (PASP) >/= is associated with 
      higher maternal mortality, a greater number of abortions and IUFD (22.62%), 
      cardiac complication (22.72%), and increased risk of preterm birth (0.5769; 95% 
      CI: 0.2801 to 1.188), but these associations are not found to be significant. 
      CONCLUSION: NYHA class was found to be a very strong predictor followed by left 
      ventricular ejection fraction for poor outcome. Maternal mortality in 
      asymptomatic patients or patients with mild symptoms (NYHA classes 1 and 2) is 
      comparable to that found in the general population. However, pulmonary artery 
      systolic pressure is not found to be significantly associated with worse outcomes 
      in our study.
CI  - Copyright: (c) 2022 Journal of Family Medicine and Primary Care.
FAU - Sharma, Nalini
AU  - Sharma N
AD  - Assistant Professor, Department of Obstetrics and Gynaecology, NEIGRIHMS, 
      Shillong, Meghalaya, India.
FAU - Khan, Dina A
AU  - Khan DA
AD  - Senior Resident, Department of Obstetrics and Gynaecology, Lady Hardinge Medical 
      College, New Delhi, India.
FAU - Das, Rituparna
AU  - Das R
AD  - Assistant Professor, Department of Obstetrics and Gynaecology, NEIGRIHMS, 
      Shillong, Meghalaya, India.
FAU - Jethani, Roma
AU  - Jethani R
AD  - Senior Resident Gynecological Oncology, Dr. B Borooah Cancer Institute, Guwahati, 
      Assam, India.
FAU - Panda, Subrat
AU  - Panda S
AD  - Associate Professor, Department of Obstetrics and Gynaecology, NEIGRIHMS, 
      Shillong, Meghalaya, India.
LA  - eng
PT  - Journal Article
DEP - 20221216
PL  - India
TA  - J Family Med Prim Care
JT  - Journal of family medicine and primary care
JID - 101610082
PMC - PMC10041180
OTO - NOTNLM
OT  - Adverse outcome
OT  - heart disease
OT  - maternal mortality
OT  - pregnancy
COIS- There are no conflicts of interest.
EDAT- 2023/03/31 06:00
MHDA- 2023/03/31 06:01
PMCR- 2022/11/01
CRDT- 2023/03/30 02:49
PHST- 2021/09/17 00:00 [received]
PHST- 2022/01/23 00:00 [revised]
PHST- 2022/01/31 00:00 [accepted]
PHST- 2023/03/31 06:01 [medline]
PHST- 2023/03/30 02:49 [entrez]
PHST- 2023/03/31 06:00 [pubmed]
PHST- 2022/11/01 00:00 [pmc-release]
AID - JFMPC-11-6752 [pii]
AID - 10.4103/jfmpc.jfmpc_1877_21 [doi]
PST - ppublish
SO  - J Family Med Prim Care. 2022 Nov;11(11):6752-6758. doi: 
      10.4103/jfmpc.jfmpc_1877_21. Epub 2022 Dec 16.