Fetal and maternal effects of rheumatic heart diseases during pregnancy

Objective: This thesis is designed to investigate the outcomes of rheumatic heart valve diseases during pregnancy, which have significant implications for both maternal and fetal health. The aim of this thesis is to assess how cardiovascular system is affected in pregnant women with rheumatic heart valve disease, analyze the complications and pregnancy outcomes observed in mothers with heart valve disease during pregnancy. For this purpose, clinical and imaging methods used in the diagnosis of pregnant women with rheumatic heart valve disease have been examined, and strategies recommended for coping with and managing treatment during pregnancy have been discussed. Additionally, this thesis aims to thoroughly examine the effects of rheumatic heart valve diseases on the fetus, with the goal of understanding the health status of fetuses exposed to this disease in mothers and laying a foundation for developing future treatment strategies. Materials and Methods: This study was designed as a retrospective cohort study by reviewing the records of 100 pregnant patients with rheumatic heart disease who presented to the Dicle University Faculty of Medicine Hospital between January 2018 and September 2023. Data were collected to evaluate the fetal and maternal outcomes of pregnant women with rheumatic heart valve disease. The study included parameters such as mode and timing of delivery, type and severity of rheumatic heart valve disease, presence of additional maternal comorbidities, medications used, cardiology recommendations, indications for cesarean section in those recommended for cesarean delivery, type of anesthesia applied, need for intensive care unit admission in the postoperative period, and discharge status. Patients with viability over 24 weeks of gestation who delivered at our hospital were included, while abortions, pregnant patients with congenital heart disease, and those with cardiac arrhythmias were excluded from the study. For assessing fetal effects, birth weight, length, and 1st and 5th minute Apgar scores of the fetus were considered. Clinical records of pregnant women with rheumatic heart valve disease were reviewed, and medical interventions, medications, and cardiac evaluations during pregnancy were recorded. Antenatal examinations, ultrasound results, cardiac evaluations, and other relevant maternal health information during pregnancy were determined. Fetal outcomes in the babies of mothers with rheumatic heart valve disease were evaluated. The health statuses of mothers and babies, delivery methods, and postpartum complications were recorded in the postpartum period. This thesis, titled "Fetomaternal Effects of Pregnant Women with Rheumatic Heart Valve Disease," was analyzed using descriptive statistics and appropriate parametric or non-parametric tests, with a significance level set at p <0.05. Local ethics committee approval was obtained from Dicle University Faculty of Medicine Hospital for this research. Participant confidentiality was maintained, and personal information was kept confidential during data analysis. Findings:In our study, the complications frequently encountered during the pregnancy process of pregnant women with rheumatic heart disease were examined. The mean age of the 100 participants was found to be 31.4 years. Mitral valve involvement was observed in the majority of patients. The most common valve disease identified was mitral insufficiency. Approximately 25% of the pregnant women had additional comorbidities, with half of these patients using medication, and benzathine penicillin G being the most commonly used medication. Ninety percent of pregnant women with valve disease underwent cesarean section, but it was determined that there was no significant difference in the indication for cesarean section among valve diseases such as mitral stenosis and insufficiency, with cesarean indications predominantly arising from obstetric reasons. Fifteen percent of the patients were followed up in the intensive care unit during the postoperative period. A significant relationship was observed between the severity of valve disease and the mode of delivery, type of anesthesia during delivery, and the need for admission to the intensive care unit in the postoperative period. In pregnant women with mild valve disease, the need for admission to the intensive care unit in the postoperative period was lower, whereas in cases of moderate and severe valve disease, this need was higher. Furthermore, cesarean section was more frequently recommended in cases of moderate and severe valve diseases, with almost all of these patients undergoing general anesthesia. The role of infective endocarditis prophylaxis was found to be significant in treatment planning. Most mothers delivered in a timely manner, and no maternal mortality was observed in our study. All patients were discharged with recovery, and the average length of hospitalization was found to be 3.4±1.4 days. Additionally, no significant difference was observed in fetal complications such as intrauterine growth retardation and low birth weight. Eighty-two percent of newborns required neonatal intensive care, mostly due to obstetric reasons and observed more commonly in preterm births. There were no stillbirths observed in our study. Conclusion: This study comprehensively investigated the maternal effects of rheumatic heart valve diseases, evaluating their impact on the cardiovascular health of expectant mothers, susceptibility to pregnancy complications, and intrauterine fetal development. Our findings indicate that rheumatic heart valve diseases increase the risks of maternal mortality and morbidity during pregnancy, while also potentially exerting adverse effects on fetal development. These results underscore the importance of pre-pregnancy counseling, regular monitoring, and appropriate treatment strategies in clinical practice, thereby emphasizing the necessity of preventive measures to safeguard both maternal and fetal health and minimize the risk of complications. Keywords: Rheumatic heart valve disease, pregnancy, fetus, maternal complications