Cardiac diseases in pregnancy leading to maternal mortality

1) To correlate age and gravida; 2) To correlate gross and histopathological findings of heart; 3) To evaluate postpartum complications and neonatal condition in maternal autopsies due to cardiac disease. This is 3 years retrospective study in a tertiary care hospital from 1 January 2015 to 31 December 2017. Total 1895 autopsies were performed by pathology department in these 3 years, out of which 158 (10.76%) maternal mortality autopsies were performed. Of which 17 (8.33%) maternal mortality autopsies due to cardiac diseases in pregnancy. The gross specimen of heart and formalin fixed paraffin embedded sections were stained with Haematoxylin and Eosin were reviewed for histopathological examination. 35.29% maternal mortality occurred due to chronic rheumatic heart disease. 29.40% maternal mortality occurred due to dilated cardiomyopathy. 23.52% maternal mortality occurred due to ventricular failure. 11.76% maternal mortality occurred due to myocarditis. Most common age group involved was between 21-30 years, mainly seen in multigravida in 13 (76.47%) cases with postpartum complications. Most common presenting complaint was breathlessness in 17 (100%) followed fever with chills in 8 (52.94%) cases. Out of 17 cases, 14 (82.35%) cases delivered normal vaginally and 12 (70.58%) cases had live baby. On gross examination of heart, it was moderate to markedly enlarged due to ventricular dilation with marked hypertrophy of left ventricular wall. On microscopic examination, myocardial muscle fibre hypertrophy with disarray of myofibers, valvulitis, myocarditis and subendocardial fibrosis seen. Pregnancy in women with heart disease is associated with high morbidity & mortality rates. So they should receive appropriate antenatal counselling & care. Proper evaluation of maternal prognosis is required prior to conception in women with heart disease. So adequate clinical follow up during pregnancy is needed for proper outcome in these patients.