Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study.

OBJECTIVE: To assess prospectively the maternal cardiovascular hemodynamic changes and obstetric outcome in women with rheumatic heart disease (RHD) and to detect predictors of poor outcome.

METHODS: This prospective observational study included 204 pregnant patients with RHD who were divided into two groups; successful pregnancy group with living fetus (n = 126) and poor obstetric outcome group with fetal or neonatal loss (n = 78). Hemodynamic changes, maternal and fetal outcome were assessed and recorded.

RESULTS: There was a highly significant difference between the two groups regarding disease criteria with more women suffering from stenotic lesions (mitral and aortic), pulmonary hypertension, previous heart failure, receiving cardiac medications and higher NYHA class (III and IV) in the poor obstetric outcome group (p < .001). These patients were more prone to maternal and fetal morbidity. Maternal age above 28 years, body mass index higher than 28, mean pulmonary artery pressure higher than 50 mmHg, NYHA class III-IV and development of heart failure or cyanosis are predictors of poor outcome (p < .001).

CONCLUSIONS: Increased maternal age and body mass index together with NYHA class III-IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.