The perinatal outcomes of pregnant women with cardiac disease

Park, Hye Won; Kim, Suk Young; Park, So Hee; Lee, Hun Yung; Rho, Hyun Suk; Oh, Hyun Myong

Abstract

OBJECTIVES
The aims of the study show the effect of cardiac disease of pregnant women on the perinatal complications and pregnancy outcomes.
METHODS
From Jan. 2001 to Nov. 2005, 29 cases of pregnant women with cardiac disease were enrolled and classified by the NYHA (New York Heart Association) classes under the supervision of cardiologist and cardiothoracic surgeon. The average age of all cases is 29.9 years olds and it consists of 13 primigravida and 16 multigravida. For the examination of cardiac function during the pregnancy, the echocardiography was performed. We evaluated the cardiac disease of pregnant woman with the underlying causes, clinical manifestations during the pregnancy, delivery mode, gestational age at birth, birth weight, Apgar score and perinatal complication.
RESULTS
All 29 cases with cardiac diseases are composed of 21 cases of NYHA class I (72.7%), 4 case of NYHA class II (13.7%) and 4 cases of NYHA class III (13.7%). There are 11 cases with congenital heart disease (37.9%), 6 cases with acquired heart disease (20.6%), 9 cases with arrhythmia (31.0%), and 3 cases with other cardiac disease (10.3%). Before the pregnancy, 6 cases of 11 cases with congenital heart disease and 5 cases of 6 cases with acquired heart disease performed the corrected cardiac surgery. Echocardiography was performed on 24 cases. It showed average ejection fraction in left ventricle of NYHA class I (13 cases) and NYHA class II, III (8 cases) were 61.5% and 52.6%, respectively. 7 cases of NYHA class I and 1 case of class II was done on the vaginal delivery. 14 cases of class I pregnant woman were performed the cesarean section according to obstetric indications but 3 cases of class II were performed the cesarean section for the prevention of cardiac risks. 4 cases of class III were performed the cesarean section according to obstetrics indications (2 cases) and for the prevention of cardiac risks (2 cases). For gestational age at birth, the average of NYHA class I was 38.1 weeks and the average of NYHA class II, III was 35.4 weeks. The average birth weight showed 3,022 gm in class I and 2,446 gm in class II and class III. Preterm birth were 3 cases (class II; 1 case, class III ; 2 cases). Low birth weight infant were 5 cases (class I; 3 cases, class II 2 cases). Intrauterine fetal death was a case (class I). Congenital abnormalities at birth were not observed in our study. Although no maternal mortality was observed, 2 cases of pulmonary edema caused by cardiomyopathy in NYHA class III and 1 case of Eisenmenger Syndrome caused by PDA in NYHA class II were developed during the labor.
CONCLUSION
In this study, the majority of pregnant women with cardiac disease had the congenital heart diseases. It also showed that they can expect good perinatal outcomes by the adequate prenatal care including cardiac surgery before the pregnancy.