Background: The physiologic hemodynamic alteration in cardiovascular system during pregnancy can result in a poor maternal outcome including mortality in patients with preexisting cardiac diseases.
Objectives: Aims of this study were to identify direct and indirect causes of maternal mortality in pregnant women dying due to cardiac causes and to identify avoidable factors if any.
Materials and methods: This is a retrospective analysis of four years data of mothers with preexisting cardiac diseases was conducted in the Dept. of Obstetrics & Gynaecology of IPGME&R in collaboration with Dept. of cardiology.
Results: A total of fifty pregnant women dying due to cardiac causes were included as subjects. Fifty age & parity controls with successful outcome were compared. Mean age the subjects was 25.36±4.34 years. Among mortality cases 34% had rheumatic heart disease, then followed by peripartum cardiomyopathy in 18%, congenital heart disease in 6% and others (hypertensive cardiac diseases, idiopathic dilated cardiomyopathy and systemic lupus erthymatosus etc.) in 42%. Direct causes of maternal mortality included right heart failure, left heart failure, pulmonary emboli, cardiomyopathy, ventricular tachycardia etc. Indirect causes observed were sepsis, heart failure during labour, postpartum stress, anaemia etc. Noticed avoidable factors were referral status, type of referral facility, regularity of ANC, logistical problems, availability of cardiological support and awareness status of patients and clinicians etc.
Conclusion: Whether maternal mortality in women with cardiac disease can be prevented or not is a debatable issue. Pregnancy outcome mainly depends on disease itself, nature of lesion, presence of facilities &other associated morbidities.
