Risk assessment and prediction of complications in pregnant women with heart disease

Abstract

Background: There is a vast improvement in the survival and quality of life of patients with both major and minor structural and functional cardiac defects. Objective of present study was to calculate CARPREG (CARdiac disease in PREGnancy) risk score and test its efficacy in predicting the occurrence of adverse maternal cardiac events in patients with heart disease.Methods: This was a prospective observational study where CARPREG score was calculated for 100 pregnant patients as soon as they were enrolled and the degree of risk and maternal complications were recorded and studied in relation to the score.Results: Out of the 100 patients included in our study, it was found that Rheumatic heart disease (69%) with isolated mitral stenosis was the predominant cardiac problem. Maternal cardiac events complicated 14% pregnancies with congestive cardiac failure occurring most frequently. The complication rate was 1.56%, 5.56% and 66.67% in patients with CARPREG score of 0, 1 and ≥2 respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CARPREG score in predicting the complications were 66.67%, 97.56%, 85.71% and 93.02% respectively. Hence, the score was efficacious in predicting the maternal cardiac complications and was found to be a statistically significant predictor of maternal complications (p value=7.39E-06).Conclusions: The CARPREG risk index has a high specificity and negative predictive value with regards to cardiac complications in pregnant women with heart disease. It may, therefore, be routinely used to improve the assessment of cardiac risk before and during pregnancy.