RISK SCORING AND OUTCOME IN PREGNANT CARDIAC PATIENTS IN APERIPHERAL TERTIARY CARE CENTRE

Abstract

Objectives: To determine types of cardiac lesions in pregnant patients according to World Health Organization (WHO) cardiac risk score and to observe frequency offetomaternal complications.

Study Design: Prospective longitudinal study.

Place and Duration of Study: This study was conducted at obstetrics and gynecology unit of Combined Military Hospital Kharian from Dec 2017 Dec 2018.

Methodology: All consecutive diagnosed pregnant cardiac patients and also recently diagnosed patients were enrolled. Estimation of maternal risk associated with pregnancy was done by classifying the patients according to the modified World Health Organization scoring system. Primary outcome was frequency of patients identified by risk scoring systems and types of lesions. Patients were followed up for the duration of pregnancy and purperieum for fetomaternal complications. Frequency of maternal morbidity and mortality due to cardiac complications was calculated.

Results: A total of 52 patients were enrolled. Mean age was 28.9 ± 4.9 years. Cardiac events complicated (38.8%) of pregnancies and there were 11(6.4%) obstetric and (37%) neonatal complications. The aetiology of maternal cardiac lesions was acquired, 30 (57.6%), congenital 12 (23.0%) and rhythm disorders in 10 (19.2%) Cardiac maternal deaths were 03 (2.4%) and there were no obstetric deaths. Prediction of cardiac complications by the scoring systems was significant as in WHO I risk was 12% rising to 100% in WHO IV.

Conclusion: The modified WHO risks score is well adjusted to predict cardiac complications. Triage of the patients according to this standardized score in peripheral hospitals will lead to timely referral of patients who score high and likewise giving confidence to deliver low risk cardiac patients at mid-level hospitals.