Maternal Heart Disease in Pregnancy: A Case Series on Lesion-specific Management and Outcomes

Background: Heart disease complicates approximately 0.2-4% of all pregnancies and remains a major cause of maternal morbidity and mortality.The physiological changes in pregnancy-such as increased cardiac output, plasma volume, and heart rate, along with decreased peripheral vascular resistance-can unmask or exacerbate pre-existing cardiac lesions.This case series highlights the maternal and fetal outcomes in three pregnant women with structural heart diseases of both rheumatic and congenital origin, managed through a multidisciplinary, lesionspecific approach.Cases: The first patient had severe aortic stenosis with severe mitral regurgitation (World Health Organization class IV) who developed pulmonary edema following a lower segment cesarean section under general anesthesia.The second patient presented with severe mitral stenosis, severe mitral regurgitation, and severe pulmonary arterial hypertension (World Health Organization class IV), who underwent an elective cesarean section.The third case was a moderate para-membranous ventricular septal defect with mild-to-moderate pulmonary arterial hypertension (World Health Organization class II-III), which underwent forceps-assisted vaginal delivery.All three patients were managed meticulously and discharged with healthy neonates and stable cardiac function, demonstrating the success of individualized multidisciplinary management.