The following is a summary of “Maternal mortality and predictors of adverse outcome in patients with heart disease in pregnancy,” published in the November 2022 issue of Primary care by Sharma, et al.
Pregnancy-related heart disease posed a significant hemodynamic challenge and was known to increase the risk of maternal morbidity and death. One of the most important factors that might affect the feto-maternal outcome is the patient’s functional level. Numerous predictors have repeatedly been researched and gathered in a variety of grading schemes. The modified WHO classification was the most recent and validated, mandating that patients with severe ventricular dysfunction (ejection fraction <30%) and pulmonary artery hypertension (PAH) fell under class IV. However, the classification and another significant risk factor, i.e., New York Heart Association (NYHA) class, was reevaluated in the current study. For a study, researchers sought to investigate three of the most significant indicators of unfavorable outcomes in patients with heart disease during pregnancy, namely functional status (NYHA class), PAH, and left ventricular ejection fraction (LVEF).
In a prospective study conducted from January 2016 to August 2017, pregnant patients with heart disease were divided based on their NYHA class, PAH, and LVEF, and the feto-maternal outcome was tracked and assessed in terms of maternal mortality, fetal demise, the likelihood of major cardiac complications, and the risk of preterm delivery.
Three maternal fatalities out of 29 (10.34%) were cardiac in nature. Contrary to our center’s overall 1. About 12% maternal death rate and patients with cardiac disease had a maternal mortality rate of 5.45%. Maternal fatalities occurred in 3 of the 17 (17.64%) patients in NYHA classes 3 and 4, but not in classes 1 or 2. Compared to patients in NYHA classes 1 and 2, patients in classes 3 and 4 had substantially higher rates of intrauterine fetal death (23.52%) and premature birth (relative risk = 0.4688; 95% CI: 0.2320 to 0.9470). The 10 individuals (100%) who experienced cardiac problems all fell into classifications 3 and 4. In comparison to patients with a greater ejection fraction, individuals with LVEF 44% had considerably higher rates of abortions (20%), intrauterine fetal death (IUFD) (40%), and cardiac complications (80%). However, the correlations were not shown to be statistically significant. Pulmonary artery systolic pressure (PASP) ≥ was linked to higher maternal mortality, more abortions and IUFD (22.62%), cardiac complications (22.72%), and a higher risk of premature delivery (0.5769; 95% CI: 0.2801 to 1.188).
The NYHA class and left ventricular ejection fraction were determined to be the two best predictors of poor outcomes. Maternal mortality was equivalent to that of the general population in individuals who were asymptomatic or had minor symptoms (NYHA classifications 1 and 2). The study did not find any evidence that pulmonary artery systolic pressure was substantially related to worse outcomes.