Pregnancy with Heart Diseases in Egypt: Spectrum and Outcome
Aim: To assess the spectrum and outcome of pregnancy with heart diseases in a large sample of Egyptian women from three tertiary hospitals in Nile delta , upper Egypt and Suez canal zone.
Background: Pregnancy is associated with increased maternal and fetal risk in many patients with heart diseases.
Subjects and methods: All pregnant women with congenital heart disease, rheumatic heart disease, ischemic heart disease, cardiomyopathies and also those with systemic hypertension, pulmonary hypertension or arrhythmias who were admitted to obstetric departments for labor in Menoufia, Assuit and Ismailia university hospitals were included from June 2013 to June 2014. All pregnant women were examined during their hospital stay ( 3-7 days) where full history, clinical data, all investigations and medications were reviewed. Also, they were followed up to 6 weeks after labor in outpatient clinics to document any complications.
Results: Out of 13047 pregnancies in one year 1203 women with heart diseases were enrolled. The maternal age ranged from 16 to 49 years with 76.2% between 19 to 29 years and 19.5% between 29 to 39 years. Caesarian delivery was reported in 51.5% of cases. Hypertension was reported in 7.4% of cases, followed by Rheumatic heart disease in 1.4% of cases, cardiomyopathies in 0.4%, congenital heart diseases in 0.022%, and finally ischemic heart disease in 0.015% of all cases. Maternal complications occurred in 214 patients representing 2% of all pregnancies and 17.8% of cases and were higher in those with valvular diseases and those with hypertension. Maternal mortality occurred in 14 cases representing 0.1% of all pregnancies and 6.5% of cases. Fetal complications occurred in 165 of cases representing 1.3% off all pregnancies. Prematurity was the most common complication occurred in 2.9% of cases while intrauterine fetal death occurred in 1.7% of cases.
Conclusion: Pregnancy with heart diseases represent a major challenge in Egypt especially those with valvular heart diseases and those with hypertension and needs more intensive management strategies .