Archives

Introduction: The overall incidence of heart disease complicating pregnancy is approximately 1%. Despite
modern cardiac care, serious maternal cardiac disease complicating pregnancy can have significant adverse
effects on maternal and fetal outcomes.
Objective: To study the fate of pregnancies in patients with Rheumatic heart disease attending a tertiary
level referral centre.
Materials and Method: A hospital based cross-sectional study was conducted in Tribhuvan University
Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Centre over a period of 12
months. Patient profile, types of valvular lesion and pregnancy outcomes were studied.
Result: A total of 91 pregnant patients with Rheumatic heart disease who underwent termination of pregnancy
at the centres at various gestational ages were studied. The commonest age group was 20 to 24 years 33
(36.3%) and most were primigravida 44 (48.3%). Mitral Stenosis was the commonest valvular lesion 65
(71.4%). Of the 91 patients, 9 (9.8%) had undergone Percutaneous transluminal mitral commisurotomy and
20 (21.9%) had undergone open heart surgery prior to pregnancy. A sum of 60 (65.9%) patients reached period
of viability and delivered after 28 week while 5 (5.4%) had termination of pregnancy in second trimester and
rest 26 (28.5%) were first trimester losses: elective abortion in 18 (19.7%) cases and spontaneous abortion
in 8 (8.7%) cases. Patients who delivered at or beyond 28 weeks had favorable pregnancy outcome (except
one still birth and neonatal death each).
Conclusion: Rheumatic heart disease continues to be of significant occurrence in pregnant patients. One
third of them reached the period of viability with good pregnancy outcome attributed to combined good
obstetric and cardiac care. However, a significant number underwent voluntary termination in first trimester
which could have been prevented by effective contraceptive counselling.

Fate; pregnancy; rheumatic heart disease.