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Pregnancy complicated by heart disease in Nepal
  1. Shailaja Chhetri1,
  2. Nikesh Raj Shrestha2,
  3. Thomas Pilgrim3
  1. 1Department of Obstetrics & Gynecology, BP Koirala Institute of Health, Dharan, Nepal
  2. 2Department of Cardiology, BP Koirala Institute of Health, Dharan, Nepal
  3. 3Department of Cardiology, Bern University Hospital, Bern, Switzerland
  1. Correspondence to Dr Shailaja Chhetri, Department of Obstetrics & Gynecology, BP Koirala Institute of Health Sciences, Dharan, Nepal; shailzac{at}hotmail.com

Abstract

Objective To investigate the prevalence, characteristics and maternal and perinatal outcomes of pregnancies complicated by heart disease.

Design Prospective single-centre registry.

Setting Tertiary care teaching hospital in eastern Nepal.

Patients Pregnant women presenting to the antenatal clinic and/or labour room between 1 March 2012 and 31 March 2013.

Main outcome measures Prevalence, characteristics, and maternal and perinatal outcomes of pregnancies complicated by heart disease.

Results Fifty-three out of 9463 pregnancies (0.6%) were complicated by cardiac disease. Proportions of acquired, congenital and arrhythmic heart disease amounted to 89%, 9% and 2%, respectively. Rheumatic heart disease (RHD) was the most frequent cardiac disease complicating pregnancy (n=47). Among 45 women with RHD continuing pregnancy until delivery, 30 (67%) were primigravidae. The predominant valvular pathology was mitral stenosis (62%), followed by mitral regurgitation (21%) and aortic regurgitation (13%). Twenty women (44%) underwent elective or emergency caesarean section. Maternal and fetal/perinatal mortality of pregnancies complicated by RHD amounted to 4% and 16%, respectively. New York Heart Association (NYHA) functional class III or class IV (HR 6.0, 95% CI 1.2 to 29.1, p=0.026), pulmonary hypertension (HR 9.1, 95% CI 1.6 to 51.5, p=0.012) and severe mitral stenosis (HR 7.0, 95% CI 1.4 to 34.4, p=0.017) were identified as predictors of maternal or fetal/perinatal mortality in an univariate analysis.

Conclusions Rheumatic mitral stenosis was the most frequent heart disease complicating pregnancy in a consecutive cohort from a teaching hospital in Nepal. Exercise intolerance, pulmonary hypertension and severe mitral stenosis were identified as predictors of maternal or fetal/perinatal mortality.

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