Synopsis and Pregnancy Outcome of Decompensated Heart Failure in Pregnancy at a Tertiary Health Care Centre in South-Eastern Nigeria: A Retrospective Study

Abstract

Background: Heart failure during pregnancy is rare, potentially serious, and complicates approximately 1% of all pregnancies. However, there is a global dearth of data on heart failure in pregnancy, and no data from southeastern Nigeria. Aim: To determine the prevalence, clinical profile, and outcomes of pregnancy in women presenting with heart failure during pregnancy at the University of Nigeria, Enugu. Methods: A hospital-based, retrospective study covering 9 years between 2013 and 2021, using data from the medical records of patients seen at the cardiology and obstetrics/gynecology units. Information on the clinical profile, echocardiographic reports, and pregnancy outcomes were obtained and analyzed. Results: Of 9749 new pregnant women, 26 (0.3%) had heart failure during pregnancy, with a prevalence rate of 0.3% and a mean age of 33.27 years. Among 26 women, peripartum cardiomyopathy (46%) was the most common cause of heart failure. The most common presenting symptoms were breathlessness (84.62%), bilateral leg swelling (69.24%), and paroxysmal nocturnal dyspnoea (65.39%). The majority presented with New York Heart Association classes III (57.7%) and IV (26.9%). The most affected age group and mode of delivery were 31-40 years (82%) and cesarean section (50%), respectively. Pregnancy outcomes showed high maternal (11.5%) and fetal/neonatal (15.4%) mortality rates. There was a significant association between the etiology and severity of heart failure (P = 0.009), and the trimester of pregnancy at presentation (P = 0.009). Conclusion: heart failure in pregnancy is associated with high maternal and fetal mortality. The most common cause of heart failure in South Eastern Nigeria was peripartum cardiomyopathy.