Key result
Multidisciplinary management cuts mortality in mitral stenosis, addressing late-pregnancy and postpartum cardiac decompensation.
Why the study?
Mitral stenosis is a common valvular heart disease during pregnancy that is poorly tolerated due to pregnancy-related cardiocirculatory changes and is a known trigger of maternal mortality if not managed adequately.
Management of mitral stenosis in pregnancy requires a specialized multidisciplinary team to address the hemodynamic burdens of pregnancy and delivery, thereby reducing maternal and fetal mortality.
Underscores high maternal-fetal risk in mitral stenosis pregnancies; leaves open need for prospective trials on intervention timing.
BACKGROUND: Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardiocirculatory changes that occur during pregnancy, labor and postpartum. OBJECTIVE: The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article. METHODS: Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide. RESULTS: Cardiac decompensation usually takes place late in pregnancy as the hemodynamic burden of pregnancy become more pronounced as well as after delivery due to an abrupt increase of preload secondary to autotransfusion and aorto-caval decompression. The maternal and fetal complications correlate with the New York Heart Association (NYHA) functional classification and the grade of mitral stenosis. Medical therapy should be tried first. If symptoms continue in spite of optimal medical therapy, invasive procedures are recommended. Several studies revealed that vaginal delivery under epidural anesthesia is endurable and of low-risk unless obstetrically contraindicated. CONCLUSION: Pregnancy and mitral stenosis remain a complex entity and a well-known trigger of maternal mortality during pregnancy and peri-partum period if not managed adequately. A good appreciation and recognition of the physiology of pregnancy and its impact on the pre-existing mitral stenosis and the presence of a specialized multidisciplinary team to handle such cases significantly decrease maternal and fetal mortality and morbidity.
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Abdelrahman et al. (2019) conducted a review in Mitral stenosis in pregnancy. Pregnancy with mitral stenosis is a complex entity where cardiac decompensation typically occurs late in pregnancy or postpartum, requiring multidisciplinary management to reduce mortality.
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