Outcome of pregnancy among parturients complicated with heart disease in Rajavithi Hospital.

Objective: To compare the maternal and perinatal outcomes at Rajavithi Hospital from January 1st, 2000 to December 31st, 2004, (5 years), (3rd period) with those occurring in the previous two periods:1st and 2nd (1965-1970, (6 years) and 1985-1990, (6 years) respectively.

Material And Method: Retrospective analysis of various medical records of 196 cases diagnosed pregnancy with heart disease.

Results: The prevalence of parturients complicated with heart disease was 0.41%, an increase of 2 and 5 times compared with the first and second period, respectively. Congenital heart disease was the most common type of disorder in the second and third period (64.28% and, 49.49%, respectively) while rheumatic heart disease was the most common disorder in the first period (54.86%). Most of the cases in the 2nd and 3rd periods were delivered by operative vaginal delivery (46.43% and 44.90%, respectively), while spontaneous vaginal delivery was the most common mode of delivery in the first period (78.99%). All of the postpartum and perinatal complications except postpartum hemorrhage were significantly higher in the worse class of NYHA (class III/IV) than those in the better class of NYHA (class I/II). The maternal death rate in the third period increased 1.81 times and 13.66 times compared with those in the first and second periods, respectively.

Conclusion: Congenital heart disease was the most common heart disease in pregnancy from 1985 to 1990 and 2000 to 2004. Patients in the NYHA class III/IV had worse maternal and fetal outcomes than those in the NYHA class I/II except for postpartum hemorrhage. Maternal mortality rate was highest from 2000 to 2004 (12.57 per 100,000 live births).