Pregnancy Outcomes in Patients with Valvular Heart Disease

comparative study conducted at Department of Cardiology, PIMS, Islamabad, from April 10th to August 31st, 2023. The study consisted 318 females, 166 of them were healthy (control group) and 152 of them had valvular heart disease (study group). SPSS version 25 was used to analyze the data. Objectives: To evaluate the pregnancy outcomes of females with valvular heart disease presenting to tertiary care hospital. Results: Group-I contained 152 females with valvular heart disease and group-II had 166 healthy females. Group-I mean age was 20.2±4.8 years, whereas group-II mean age was 22.3±2.8 years (p>0.05). Stillbirths were greater in group-I 10(6.57%) and 2(1.20%) (p 0.001) than group-II. Mitral stenosis was the most common valvular lesion at 53.97% (82 patients). 18.42% (28 patients) had mitral regurgitation. The study group had 0.65% maternal mortality compared to 0% in the control group. 11 (7.23%) patients developed cardiac arrythmias in study group compared to 2 (1.20%) patients in control group. Conclusions: There is a high risk of pregnancy in pregnant females who has valvular heart disease is a and have higher probability of having fetomaternal complications.


Original Article
In younger women with valvular heart disease, rheumatic heart disease, congenital conditions, and earlier endocarditis are more probable [1].These disorders enhance pregnancy risk factors for both mother and baby [2].Pregnancy frequently causes valvular heart disease.During pregnant, maternal physiological changes increase cardiac output and blood volume, possibly revealing a heart disease [3].Rheumatic fever, particularly in immigrants from impoverished countries, induces most acquired valvular lesions [4].The presence of valvular disease in pregnant women who are at risk for adverse outcomes is exacerbated due to its impact on functional capacity, left ventricular function, and pulmonary pressure [5].

M E T H O D S
six weeks [10,11].The proportion of persons with severe CHD who develop and procreate has grown in industrialized nations.CHD causes 30%-50% of all cardiac problems in pregnant women [12].The incidence of clinically severe maternal cardiac disease during pregnancy is very low, accounting for fewer than 1% of cases but carries adverse fetomaternal outcomes [13].Depending on disease severity, pregnant VHD patients require periodic risk assessment and customized therapy.This study aimed to evaluate the pregnancy outcomes of females with valvular heart disease presenting to tertiary care hospital.

R E S U L T S
This was a descriptive comparative study was conducted at Department of Cardiology, PIMS, Islamabad, from April 10th to August 31st, 2023.The study consisted 318 females, 166 of them were healthy (control group) and 152 of them had valvular heart disease (study group).Interviews, physical tests, and medical records were used to gather data.Demographic information, medical history, type of valvular heart disease, NYHA class, pregnancy outcomes, and mode of delivery were all gathered.SPSS version 25 was used to analyze the data.The sample size was calculated as n = (Z/2)2 * p * (1-p) / d2, where n is the required sample size, Z/2 is the standard normal deviation at 95% con dence (1.96), p is the estimated proportion of patients with valvular heart disease (0.5), and d is the desired level of precision (0.05).As a consequence, the research group included 152 individuals, whereas 166 healthy controls were enrolled for comparison.The convenient sampling approach was utilized, and participants were chosen based on their availability and desire to participate in the research.Females with other cardiac disorders, such as congenital heart disease, coronary artery disease, and cardiomyopathy, were excluded from the study.Females who had already heart surgery or valve replacement were also excluded.Pregnant women with additional medical disorders that potentially impair pregnancy outcomes, such as diabetes, hypertension, or renal disease, were also barred from participating in the trial.Females with insu cient medical records or who did not provide permission were likewise barred from participating.The college of physicians and surgeons Pakistan, institutional review board accepted the study, which was carried out in compliance with all applicable ethical standards.Patient data were anonymzed to ensure con dentiality, and all study followed Helsinki Declaration standards.mean age was 22.3±2.8years (p>0.05).Group-I had a mean parity of 0.90±1.05,whereas group-II had 0.86±0.92(p>0.05).Obstetric history differed across groups.34(22.36%)group-I females and 9(5.42%) group-II females had abortions (p < 0.001).Stillbirths were greater in group-I 10(6.57%) and 2(1.20%) (p 0.001) than group-II.Both groups had similar preterm birth rates (p>0.05).Group preferences were similar.Most women in both groups scheduled, unbooked, or engaged in prenatal care (p>0.05).13(8.55%)initially visited in the rst trimester, 74 (48.68%) in the second, and 63(41.44%) in the third in group-I.Group-II had 14(8.43%)rst-trimester visits, 80(48.19%) in the second, and 69(41.56%) in the third (p>0.05).This relevant information is presented in Table 1.
This study examined 318 pregnant females divided into group-I and group-II.Group-I contained 152 females with valvular heart disease and group-II 166 healthy females.Group-I mean age was 20.2±4.8 years, whereas group-II  Finally, the study group had 0.65% maternal mortality compared to 0% in the control group Table 3.  GW and collaborators [16].This study also discovered that the majority of valvular heart disease patients were in NYHA Class I, suggesting that the disease was well-controlled and had no substantial in uence on their pregnancy outcomes.This is consistent with previous study conducted Salem DN and colleagues, who demonstrated that well-controlled valvular heart disease had no effect on pregnancy outcomes [17.The analysis additionally identi ed a signi cant difference in method of delivery between the study group and the control group, with the study group having a greater rate of instrumental delivery.This is consistent with previous study by Rychik J et al., who indicated that individuals with valvular heart disease may be at a greater risk of problems during delivery, suggesting the use of an arti cial birth channel [18].The research also highlights the issue of the long-term health of the mother and child as a result of valvular heart disease.Previous studies by Bonow and colleagues as well as Meissner et al., has shown that pregnant female with VHD are more likely to have heart failure or other cardiac issues later in life [19,20].To prevent long-term implications, healthcare practitioners must regularly monitor these individuals and offer proper follow-up treatment.Overall, the study emphasizes the need of adequate therapy and monitoring of pregnant females with valvular heart disease in order to achieve improved pregnancy outcomes.More study is required to investigate the in uence of various forms of valvular heart disease on pregnancy outcomes and to determine the most effective treatments for these patients.

Complications
Table 4 describes the fetal outcomes and obstetric issues that mother can during birth.P-values < 0.05 are describing that there is a signi cant difference between group-I and group-II of complications.

Table I :
Demographic Description of Group1 and Group2

Table 2 :
Investigation of Valvular lesions

Table 5 :
Patients delivery methods

Table 3 :
Patients parental history

Table 4 :
Fetal Outcomes and Major Obstetric Issues 76% of group-I and 79% of group-II gave birth vaginally.11% of group-I and 13% of group-II delivered via caesarean section, the second most prevalent procedure.13% of group-I and 8% of group-II needed instrumental delivery.Table-V With a p-value of 0.001, According to this research, pregnant females with Valvular heart disease had a greater risk of unfavorable pregnancy outcomes than healthy pregnant females.It is critical to handle and monitor these patients properly in order to achieve improved pregnancy outcomes.DOI: https://doi.org/10.54393/pjhs.v4i10.1094 Pregnancy Outcomes in Patients PJHS VOL. 4 Issue.10 October 2023 Copyright © 2023.PJHS, Published by International Publishers