Maternal and neonatal complications in pregnant women with mitral stenosis

Olga Perelshtein Brezinov*, Michal J. Simchen, Sagit Ben Zekry, Rafael Kuperstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Rheumatic mitral stenosis (MS) is a relatively rare diagnosis in the developed countries. Its treatment during pregnancy is challenging due to hemodynamic changes. With the demographic changes due to recent waves of immigration, an increase in the prevalence of rheumatic heart disease is expected. Objective: To evaluate maternal and neonatal complications in patients with mitral stenosis. Methods: During the years 2006-2017, 22 women who underwent 31 pregnancies were followed at the Sheba Medical Center in Israel. We collected data regarding hemodynamic changes and their clinical course. MS was classified as mild, moderate, or severe according to mitral valve area by echocardiography. Maternal and fetal adverse events were evaluated according to severity of MS and compared by Poisson regression modeling. Results: MS was severe in 7 pregnancies (22.6%), moderate in 9 (29%), and mild in 15 (48.4%). Twenty patients were managed conservatively and 2 underwent a successful percutaneous mitral balloon valvuloplasty (PBMVP) during pregnancy. All pregnancies ended with a liveborn neonate and no maternal mortality. Peak and mean mitral pressure gradients increased during pregnancy from 13.3 ± 5.3 to 18.6 ± 5.1 mmHg and from 5.9 ± 2.3 to 9.6 ± 3.4 mmHg respectively (P < 0.05). Eight pregnancies (25.8%) were complicated by pulmonary congestion, 2/15 (13.3%) with mild MS, 2/9 (22.2%) with moderate, and 4/7 (57.1%) with severe MS. The adverse event rate was higher among patients with severe MS compared with moderate and mild MS [hazard ratio (HR) 3.15, 95% confidence interval (95%CI) 1.04-9.52 and HR 4.06, 95%CI 1.4-11.19 respectively, P < 0.05]. Nine of 31 deliveries were vaginal; 6 of 22 cesarean sections (27.3%) were performed for cardiac indications. Conclusions: The number of total adverse events was higher among patients with severe MS. Patients with moderate and mild MS should be treated attentively, but good obstetric and maternal outcome can be expected.

Original languageEnglish
Pages (from-to)88-93
Number of pages6
JournalIsrael Medical Association Journal
Volume21
Issue number2
StatePublished - Feb 2019

Keywords

  • Echocardiography
  • Maternal complications
  • Mitral stenosis (MS)
  • Pregnancy outcome
  • Rheumatic heart disease

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