Maternal and fetal outcome in women with rheumatic heart disease: a 3-year observational study

To assess prospectively the maternal and fetal outcome in women with rheumatic heart disease (RHD).

This was a prospective 3-year observational study carried out at Menoufia University Hospital, Egypt in which 192 patients out of 9856 pregnant women were diagnosed with RHD and divided into two groups: low- and high-risk groups based on the New York Heart Association (NYHA) functional classification. Enrolled patients were followed to assess the maternal and fetal outcome.

Mitral valve disease was the commonest single valve (118/192, 51.4 %) affected by rheumatic fever. Cardiac women with NYHA class I&II characterized by having fewer pulmonary hypertension, taking cardiac medications, prior heart failure and prior cardiac surgery than those with NYHA class III&IV. On the hand, cardiac women with NYHA III&IV have poorer maternal outcome with more complications as heart failure, arrhythmias, thromboembolism, admission to cardiac ICU, delivery by cesarean section and defective lactation. Prematurity and NICU admission were significantly more in NYHA III&IV.

RHD still constitutes a major cause of maternal and fetal morbidity and mortality. Multidisciplinary cooperation, proper preconception and antenatal care are the key measures to improve the outcomes of these patients.