Key words: pregnancy, heart disease, maternal outcome, fetal
outcome, cardiac complication
Introduction
Previously, the high maternal mortality in cardiac patients
who became pregnant prompted the assertion: Women with an
abnormal heart should not become pregnant.1 This long-standing
notion needs to be revised today. Perloff2 reported a progressive
and substantial reduction in maternal death and improved
fetal outcome in pregnant women with heart disease.
Nevertheless, heart disease remains a leading cause of nonobstetric
maternal death during pregnancy.3
With increasing experience, it has become clear that not all
clinical situations carry the same ominous prognosis. While
pregnancy remains prohibitive under some conditions (e.g.,
pulmonary vascular disease) or associated with significant
maternal morbidity (e.g., mitral stenosis), other conditions,
such as mitral valve prolapse, have a benign course during gestation.
In addition, medications used during pregnancy may influence
outcome. Therefore, patients should be evaluated for
underlying cardiac disease to select appropriate management.
Clearly, risk stratification influences therapeutic decisions
during pregnancy as does counseling about future gestations.
The present study is a report of experience with the largest
published series of pregnant women with cardiac disease
cared for by the same team of physicians in one institution.