Structural heart disease in pregnancy in El-Minia localities

Pregnancy of women with heart disease is still a challenging condition because it is associated with elevated maternal and fetal morbidity and mortality. In the clinical setting, an accurate individual risk assessment is of fundamental importance. The current study was carried out in the Department of Cardiology, & the Department of Obstetrics, El-Minia University during the period from January 2009 to December 2009. We surveyed 150 pregnant ladies with structural heart disease as a part of the Euro Heart Survey on pregnancy & heart disease; they were followed up till 6 weeks postpartum. The follow-up of 121 cases during pregnancy and postpartum period was completed; there were 23 cases still pregnant while the follow-up of 6 cases was missed. So we included the 121 cases in our statistical analysis regarding maternal and fetal events during pregnancy, delivery & postpartum. Inclusion criteria: All patients with structural heart disease, valvular heart disease, congenital heart disease, ischemic heart disease, cardiomyopathy, pulmonary hypertension presenting with pregnancy, independent of age, any concomitant diseases and type of heart disease had been enrolled. Structural heart disease was diagnosed through full history taking, clinical examination and investigations such as ECG & echocardiography. Exclusion criteria: Non-structural heart disease even arrhythmias occurring in the context of a normal heart. A follow-up of all patients had been performed for at least 6 weeks after delivery using telephone contact or in our outpatient clinic (for heart disease with pregnancy) in the El-Minia University Hospital. 78% cases were with valvular heart disease, 7.3% with congenital heart disease, 10.7% with cardiomyopathy, 2% with ischemic heart disease while 0.6% cases with Lutembacher syndrome and 1.3% cases with pulmonary hypertension. Maternal cardiovascular complications during pregnancy were heart failure 6.6%, thrombotic complications: 0.8%, arrhythmia 1.6%, and hemorrhagic complications 2.5%. Maternal mortality was 3.3%, 30.4% of the high-risk group suffered from maternal complications in comparison to only 9.5% of the women at low-risk. Accordingly, the high-risk group 30.4% had a 3.1-fold greater severe maternal event rate; maternal mortality was 8.2% of the women in high-risk group versus 0% in the low-risk group. Also fetal complications occurred in 14.3% of the high-risk group versus 0% in low-risk group. APGAR score and birth weight were much lower in the high-risk group (p value 0.001). RHD is the commonest cardiac lesion among pregnant women. Peripartum cardiomyopathy was the 1st etiology of heart failure in our study but fortunately it had a good prognosis.