Cardiac diseases during pregnancy and periperium: 13 years in the ICU

Abstract

Introduction: Pregnancy, labour and the postpartum period constitute major stresses on the cardiovascular system. Patients with heart disease may decompensate due to the physiologic changes that occur during pregnancy and may develop a cardiac event with obstetric events. Methods: A retrospective collection of data for all obstetric patients admitted to our ICU in a 13-year period (September 1995 to September 2008). Data collected include the antepartum or peripartum heart status (abnormal finding on physical examination, ECG and echocardiography), reason for admission, stay on the ICU prognostic scoring (APACHE II, Obstetrical SAPS) and the outcome. Results: During 13 years there were 42 obstetric admissions to our ICU. The reason for admission was due to pulmonary edema 16 (38.1%) cases, hemorrhagic shock 11 (26.2%) cases, cardiogenic shock 8 (19%) cases, pulmonary emboli 4 (9.5%) cases, stroke 2 (4.8%) cases and recent myocardic infarction 1 (2.4%) case. Admission was unplanned for 36 (85.7%) parturients following emergency caesarean section. Status of the heart was severe aortic or mitral stenosis 21 (50%) cases, mitral or aortic regurgitation with heart failure 5 (11.9%) cases, mechanical prosthetic valve requiring anticoagulation 8 (19%) cases, myocardial infarction 1 (2.4%) case and peripartum cardiomyopathy 7 (16.6%) cases. The median duration of stay was 4 days (range 1 to 11 days), median Obstetrical SAPS was 19.3 (range 10 to 32) and APACHE II score was 13 (range 8 to 32). There were five (11.9%) maternal deaths, due to two cases PPCM, one cerebral death and two prothesis thrombus. Conclusions: The majority of the cases of parturients was unbooked for antenatal care; this leads us to acknowledge the existence of risk factors related to pregnancy. Maternal functional class is an important predictor of outcome; a high index of suspicion for cardiac diseases is essential to identify risk [1], once these patients are referred for a cardiologic opinion there is a needed for cardiologist to develop a systematic approach to their evaluation. Ideally these considerations should be commenced during prepregnancy consultations, but continued throughout pregnancy and the postpartum period [1].