Assessing Feto-Maternal Outcomes in Pregnant Women with Heart Disease: Insights from a Tertiary Care Center Experience

Abstract

Objective: To evaluate fetomaternal outcomes in pregnancies complicated by pre-existing cardiac disease and establish the clinical significance of early diagnosis, multidisciplinary care, and context-specific management strategies in resource-limited settings.

Methodology: A prospective observational cohort study conducted at the Department of Obstetrics & Gynecology, BBH and RMU's Allied Hospitals, Pakistan (January 1 - August 31, 2019) involving 27 pregnant women with confirmed cardiac lesions. Standardized protocol included: Patients: Comprehensive evaluation of maternal demographics, cardiac history, and NYHA classification Interventions: Multidisciplinary team management, echocardiographic assessment, and tailored delivery planning Outcome Measures: Maternal (delivery mode, CCU admissions, mortality) and fetal parameters (gestational age at delivery, stillbirths, NICU admissions). Data was analyzed through descriptive statistics.

Results: The cohort (N=27) predominantly comprised young mothers, with 66% (n=18) aged 20-30 years and 70% (n=19) presenting in the third trimester. Rheumatic heart disease emerged as the principal etiology (70%, n=19), followed by peripartum cardiomyopathy (18%, n=5) and congenital heart disease (11%, n=3). Functional capacity assessment revealed 78% (n=21) of NYHA Class I/II patients, while 22% (n=6) progressed to Class III/IV. Maternal complications arose exclusively in Class III/IV patients (22%, n=6), with a corresponding maternal mortality rate of 22% (n=6) concentrated among unbooked cases diagnosed during pregnancy. Cesarean deliveries predominated (70%, n=19), contrasting with 30% (n=8) vaginal births. Fetal outcomes demonstrated 89% live births (n=24), though 35% (n=8/24) required NICU admission due to prematurity. Stillbirths occurred in 11% (n=3), primarily associated with decompensated maternal cardiac status. Critical temporal patterns emerged, with 66% (n=18) of cardiac diagnoses established during pregnancy rather than preconception.

Conclusions: Delayed cardiac diagnosis (66% identified during pregnancy) correlated strongly with adverse outcomes, particularly in unbooked patients. While cesarean prevalence (70%) reflects clinical caution toward high-risk pregnancies, the 89% fetal survival demonstrates effective crisis mitigation. The 22% maternal mortality rate - disproportionately affecting late-presenting patients - underscores the critical need for pre-conception screening and early antenatal registration systems. This evidence supports developing context-specific protocols combining cardiological surveillance with obstetric care in resource-constrained environments.

Keywords: Fetomaternal outcomes, cardiac disease, Multidisciplinary care, NYHA classification, Maternal complications.