Maternal and fetal outcomes in rheumatic heart disease in pregnancy

Dhivya Sethuraman, Nirmala Ramachandran, SAP Noorjahan, Vijay Kanna


Background: Rheumatic Heart Disease remains the most common type of heart disease in pregnancy in developing countries. Over a period of 2 years,129 pregnant patients with Rheumatic Heart Disease attending our outpatient department, were observed from admission till discharge and the clinical course during pregnancy and the maternal, foetal outcomes, and desire of future contraception studied.

Methods: Patients were routinely examined every antenatal visit for signs of anemia and congestive cardiac failure. They were usually admitted at 28-32 weeks of gestation unless they presented with symptoms of cardiac failure earlier in pregnancy. Frequency of the antenatal visits depended on the functional cardiac status.

Results: The incidence of heart disease was 0.96% for all deliveries during our study period. The incidence of RHD was 71.6%. 65.1% of women gave a h/o rheumatic fever. 45(34.9%) patients had undergone surgical correction and 84(65.1%) did not undergo surgical correction. 95.3% had moderate to severe disease but only 18.6% were in NYHA class III/IV. Hence severity of disease did not correlate with NHYA class. 76.7% of women had vaginal delivery. LSCS was done for obstetric reasons alone.

Conclusion: The association of the pre pregnancy functional class with the risk of maternal events raises attention to the possibility of reducing these complications in pregnant women with mitral stenosis by means of early interventions aimed at improving their functional class.



Rheumatic heart disease, Mitral stenosis, Congestive cardiac failure, Pregnancy

Full Text:



Mudaliar and Menons Textbook of Clinical Obstetrics. Diseases of the Cardiovascular System 2005. 195-199.

Williams Textbook of Obstetrics 2005. Cardiovascular Diseases.1017-1023.

Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet. 2003 Aug;82(2): 153-9.

Charlotte L. Deans, Anselm Uebing, PhilipbJ. Steer. Cardiac disease in Pregnancy. Progress in Obstetrics and Gynaecology, 17th edition 164-183.

Sawhney H, Aggarwal N, Suri V, Vasishta K, Sharma Y, Grover A. Maternal and perinatal outcome in rheumatic heart disease. Int J Gynaecol Obstet. 2003 Jan;80(1):9-14.

Malhotra M, Sharma JB, Arora P, Batra S, Sharma S, Arora R. Mitral valve surgery and maternal and fetal outcome in valvular heart disease. Int J Gynaecol Obstet. 2003 May;81(2):151-6.

Routray SN, Mishra TK, Swain S, Patnaik UK, Behera M. Balloon mitral valvuloplasty during pregnancy. Int J Gynaecol Obstet. 2004 Apr;85(1): 18-23.

Desai DK, Adanlawo M, Naidoo DP, Moodley J, Kleinschmidt I. Mitral stenosis in pregnancy: a four-year experience at King Edward VIII Hospital, Durban, South Africa. BJOG. 2000 Aug;107(8): 953-8.

Laura L. Klein, MD, Henry L. Galan, MD. Cardiac disease in pregnancy. Obstet Gynecol Clinics of North America 31(2004)429-459.

Acute rheumatic fever and Rheumatic Heart Disease: CMDT 2007 414-416.

DeepK Lahiri, Padmavati S. Present status of rheumatic fever and rheumatic heart disease in India. Indian Heart J. 1995 Jul-Aug;47(4):395-8.

Silversides CK, Colman JM, Sermer M, Siu SC. Cardiac risk in pregnant women with rheumatic mitral stenosis. Am J Cardiol 2003;91:1382-5.

Suman Bhanderi, K Subramanyam, N Trehan. Valvular Heart Disease: Diagnosis and Management. JAPI. VOL 55. AUGUST 2007.

Uygur D, Beksaç MS. Mitral balloon valvuloplasty during pregnancy in developing countries. Eur J Obstet Gynecol Reprod Biol. 2001 Jun;96(2):226-8.

Oakley C, Doherty P. Pregnancy in patients after valve replacement. Br Heart J. 1976 Nov;38(11): 1140-8.