1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Acquired Heart Disease in Pregnancy: Assessing Maternal and Perinatal Outcome Eliza M.N (1), Quek Y.S. (1), Woon S.Y. (1), Ravichandan N. (2), Ravichandran J. (1) 1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital ObjectivesResultsConclusions References The prevalence of maternal heart disease during pregnancy is estimated at 0.5-1% and is increasing. Rheumatic heart disease is most prevalent in developing countries and most of these patients are detected to have heart disease once embarking on their pregnancy. Pregnancy induces haemodynamic changes ( increased intravascular volume and cardiac output, decreased systemic vascular resistance and hypercoaguble state) which are associated with increased risk for mother and foetus when maternal heart disease is present. This study is to assess the maternal and perinatal outcome in patients with acquired heart disease. Our study provides a contemporary assessment of maternal and neonatal risk associated with pregnancy in women with heart disease who are receiving comprehensive prenatal care. The cardiac event rate in our study was also lower compared to previous study. The neonatal mortality rate and preterm labour was also lower compared to previous studies as well. Poor NYHA class was predictive of neonatal events or pretem labour as these patients were more likely to require delivery or induction at an earlier gestation. Patients with acquired heart disease in pregnancy is able to have a good pregnancy and perinatal outcome if they are followed up well under a multidisciplinary team involving the cardiologist and obstetrician. They are able to reach term with few complications Results OPTIONAL LOGO HERE Methods Prospective observational study in 89 pregnant women diagnosed with having acquired heart disease for 1 year duration These patients were managed by the combine obstetrician and cardiologist. The demographic data of the patients was observed.Patients were monitored throughout their pregnancy and their outcomes, cardiac event, mode of delivery, intrapartum event and perinatal outcome were observed and recorded. Results Table 1. Demographic characteristics of study group The majority of patients were from the malay ethnicity and this may be contributed from the fact that they are the highest population in the country (Table 1). Majority of our patients had chronic rheumatic heart disease. Type of acquired heart disease and occurrence of cardiac events were stated in Table 2. 1. Jastrow N, Meyer P, Kahiry P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int. J Cardiol 2011;151:209-213. 2. Ruth C., Swan L., Steera PJ. Cardiac disease in pregnancy. Curr Opinion Obstet Gynecol 2009;21:508-513. 3. Willem D., Eric B., Balci A., et al. Predictors of pregnancy complications in women with congenital heart disease. European Heart J 2010;31:2124-2132. 4. Samuel CS, Sermer M, Colman JM, et al. Prospective Multicenter Study of Pregnancy Outcomes in Women with Heart Disease. Am Heart Assoc Circulation 2001; 104:515-521. 5. Paul K., Ouyang DW., Fernandes SM., et al. Pregnancy Outcomes in Women with Congenital Heart Disease. Am J Heart Assoc 2006; 113:517-524. CharacteristicsAcquired Heart Disease (n = 89) Maternal Age (years)30.58 ± 5.31 Ethnic Groups Malay66 (74.2) Chinese7 (7.9) Indian10 (11.2) Others6 (6.7) Body Mass Index (kg/m 2 )23.59 ± 5.08 Parity1.66 ± 1.45 Grandmultipara (Para ≥ 4)3 (3.4) Data presented as mean ± SD or n (%). Table 2. Heart disease and cardiac event in study group Acquired Heart Disease (n = 89) Type of Heart Disease Chronic Rhematic Heart Disease71 (79.8) Mitral Valvle Prolapse with Mitral Regurgitation8 (9.0) Cardiac Arrhythmias5 (5.6) Non-peripartum Cardiomyopathy4 (4.5) Ischemic Heart Disease1 (1.1) History of Heart Surgery13 (14.6%) Type of Heart Surgery Percutaneous Transmitral Balloon Commisurotomy (PTMC)5 (5.6) Mitral Valve Replacement3 (3.4) Aortic Valve Replacement3 (3.4) Mitral Valve + Aortic Valve Replacement1 (1.1) Coronary Artery Bypass Graft (CABG)1 (1.1) Presence of Cardiac Event Yes5 (5.6) No84 (94.4) Onset of Cardiac Event Antepartum3 (60) Postpartum2 (40) Type of Cardiac Event Heart Failure4 (4.5) Maternal Mortality1 (1.1) Data presented as n (%). Majority of patients were delivered vaginally. There were 4 cases complicated with post-partum haemorrhage required blood transfusion (Table 3). As for the perinatal outcome, 14 of the babies required admission to NICU and 5 of these admissions were due to prematurity. There was only 1 case noted to have ventriculomegaly secondary to warfarin treatment. The mean APGAR SCORE was 8.8 and the mean birthweight achieved was 2.9kg (Table 4). Table 3. Obstetric Outcomes of study group CharacteristicsAcquired Heart Disease (n = 89) Mode of Delivery Spontaneous Vertex Delivery50 (56.2) Elective Caesarean Section12 (13.5) Emergency Caesarean Section14 (15.7) Instrumental Assisted Vaginal Delivery12 (13.5) Mean Gestational age (weeks)37.69 ± 2.67 Preterm Delivery17 (19.1) Estimated Blood Loss (mls)352.81 ± 318.05 Blood Transfusion required4 (4.5) Data presented as n (%) or mean ± SD. Table 4. Neonatal Outcomes Characteristics of study group Neonatal OutcomesAcquired Heart Disease (n = 89) Birth Weight (kg)2.92 ± 0.55 Apgar Score at 5 minutes8.80 ± 1.35 Admission to NICU14 (15.7) Length of Neonatal ward stay (day)1.19 ± 4.92 Data presented as mean ± SD or n (%).