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Multidisciplinary management of heart disease in pregnancy: a single centre experience
  1. M Singh,
  2. A Bolger,
  3. M Khare
  1. University Hospitals of Leicester, Leicester, UK

Abstract

Background Heart disease in pregnancy is a leading cause for maternal morbidity and mortality as highlighted by CEMACH (2003–2005).

Methods and results 60 women (59 singletons and one twin) with heart disease were seen jointly by maternal medicine team and cardiologist in 4 months. 22 patients had congenital heart disease, 21 had arrhythmias, 5 had cardiomyopathies, 3 had acquired valvular disease, 7 had persistent cardiac symptoms in pregnancy and 1 had collagen tissue disorder. Mean age of these women was 27.8 years and at each visit, symptoms were evaluated using NYHA classification. Three women were NYHA 2 pre pregnancy and remaining were NYHA 1. 27 women had Toronto risk score of 1 and 33 had a score of 0. Nine women were on medication such as flecanide, sotalol, bisoprolol and propranalol.

19 of the 59 (32%) had caesarean sections (CS) 17 for obstetric indications, 1 for cardiac reason and one for cardiac and obstetric indications. Two women had planned admission to intensive care postoperatively following planned CS. 40/59 patients (65%) had vaginal delivery and one had a spontaneous abortion at 18 weeks gestation. The average neonatal birth weight was 3.08 kg and there was no adverse neonatal outcome. 27 women had fetal echocardiography.

Conclusion Cardiac diseases of varying severity were managed with good outcome for mother and baby. This has been possible because of a joint clinical approach between Obstetric and cardiology team, which enabled early risk stratification and effective planning for pregnancy and delivery.

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