In critically ill obstetric patients with heart disease, maternal mortality was 21% and was significantly linked to higher SOFA scores; peripartum cardiomyopathy was most common (56.5%).
Critically ill obstetric patients with heart disease face high maternal mortality (21.0%) and adverse fetal outcomes, primarily driven by peripartum cardiomyopathy and rheumatic heart disease, underscoring the need for early antenatal screening.
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Abstract Background A major factor in maternal morbidity and mortality is maternal obstetric morbidity, which includes cardiac diseases. The present study was designed to study the incidence and prevalence of cardiac diseases in critically ill obstetric patients, and their outcomes after an intensive multi-disciplinary management at a tertiary care center. Both primary cardiac etiologies and pregnancy-related cardiac involvement were included. Methods A retrospective analysis was conducted at a tertiary care center. Those who were critically ill, and either had pre-existing cardiac disease or had acquired it while in the intensive care unit were included. Demographic details, medical and obstetric history, clinical investigations, and management information were recorded. Results A total of 62 critically ill obstetric patients with cardiac diseases admitted over a duration of one year were retrospectively studied. The mean age of the patients was 28.32 ± 4.62 years. Despite the vast majority (93.5%) of the cases being booked, a significantly high number of the patients (83.9%) were diagnosed with heart disease in the post-partum period. The two most common cardiac etiologies were peripartum cardiomyopathy (56.5%) and pre-existing rheumatic heart disease (33.9%). Pulmonary edema (48.4%) and sepsis (19.4%) were the most frequent complications. A total of 72.2% required mechanical ventilation. Cardiogenic shock was reported in 14.5% of the cases with mean duration of vasopressor support of 2.90 ± 5.9 days and a mean number of 1.30 ± 1.8 blood transfusions. Higher Sequential Organ Failure Assessment (SOFA) scores were substantially (P 0.05) related to maternal mortality, which was 21.0% in our study group. In 62.9% of patients, emergency cesarean sections were carried out and a small proportion (1.6%) required cesarean delivery with hysterectomy. Fetal outcomes reported 35.5% intrauterine fetal death and 48.3% live and healthy births. Few deliveries (8.1%) required neonatal intensive care unit (NICU) support, and there were instances of neonatal deaths (1.6%) and stillbirths (6.4%). Conclusion Significant morbidity and mortality are associated with heart diseases during pregnancy and peri-partum period. Most crucial is early diagnosis and management through routine cardiac examination during antenatal visits. Improving outcomes requires pre-pregnancy counseling and interdisciplinary management.
Sharma et al. (Sat,) reported a other. In critically ill obstetric patients with heart disease, maternal mortality was 21% and was significantly linked to higher SOFA scores; peripartum cardiomyopathy was most common (56.5%).