The Special Problem of Rheumatic Heart Disease in Pregnant Women

The course of 355 pregnancies has been studied in 277 women in whom a firm diagnosis of cardiac disease had been made. In 236 of these the diagnosis was rheumatic heart disease, and the predominant lesion was mitral stenosis. The added burden imposed by pregnancy upon the heart has been analyzed quantitatively. It is exemplified by the fact that about 15,000 extra beats are made per day. The maximum is passed some weeks before term. There have been three deaths connected with 298 pregnancies in the women with rheumatic heart disease. Four years after the pregnancy only a few were worse, most were in the same functional class as before pregnancy, and 27 were actually better. In this experience there was no evidence that pregnancy once survived had accelerated the course of heart disease. The management of heart disease in pregnant women is seldom a problem of the use of digitalis or diuretics. It is a matter of preventing and controlling congestive phenomena by understanding and controlling the total burden on the heart. Under good management this burden can be safely endured by almost every woman with heart disease.