A study on the various outcomes in pregnancy in women done in Madras Medical College

1. Pregnancy outcomes in women with
heart disease: the Madras Medical
College Pregnancy And Cardiac (M-
PAC) Registry from India
Dr. Adnan Ali Khan
SENIOR RESIDENT
DEPARTMENT OF CARDIOLOGY

2. • BACKROUND:
• The haemodynamic changes of pregnancy can have a
negative impact on maternal cardiac health, especially
in women with preexisting cardiac disease.
• Pregnancy counselling and management for women
with heart disease is being increasingly recognized as
an important aspect of their overall cardiac care
• While our current understanding of pregnancy risk
assessment and management has improved over the
past 20 years, many questions can only be answered
by collaborative efforts

3. • AIMS AND OBJECTIVES
• To evaluate the feto-maternal outcome, identify the
adverse outcome predictors and test the applicability
of modified WHO (mWHO) classification in pregnant
women with heart disease (PWWHD) from Tamil
Nadu, India.
• Maternal mortality and composite maternal cardiac
events (MCEs) were the primary outcomes.
Secondary outcomes were foetal loss and composite
adverse foetal events (AFEs).

4. • METHODS AND RESULTS
• One thousand and five pregnant women (mean
age: 26.04 ± 4.2) with 1029 consecutive
pregnancies were prospectively enrolled from
July 2016 to December 2019 in the Madras
medical college pregnancy and cardiac (M-PAC)
registry.

5. • RESULTS:
• Majority (60.5%; 623/1029) had heart disease (HD)
diagnosed for the first time during pregnancy.
• Rheumatic HD (42%; 433/1029) was most common.
• One third (34.2%; 352/1029) had pulmonary
hypertension (PH).

6. • MCEs occurred in 15.2% (156/1029; 95% CI: 13.0–
17.5) pregnancies.
• Heart failure was the most common MCE (66.0%;
103/156; 95% CI: 58.0–73.4)
• Maternal mortality was 1.9% (20/1029; 95% CI: 1.1–
2.8), with highest rates in patients with prosthetic
heart valves (PHVs) (8.6%; 6/70)

7. • Left ventricular systolic dysfunction (LVSD), PHVs,
severe mitral stenosis, PH and current pregnancy
diagnosis of HD were independent predictors of
MCE.
• The c-statistic of mWHO classification for predicting
MCE and maternal death were 0.794 (95% CI: 0.763–
0.826) and 0.796 (95% CI: 0.732–0.860).

8. • 91.2% (938/1029; 95% CI: 89.392.8) of
pregnancies resulted in live births. 33.7%
(347/1029; 95% CI: 30.8–36.7) of pregnancies
reported AFEs.

9. • CONCLUSIONS
• Maternal mortality is high in PWWHD from India.
Highest death rates occurred in women with PHVs,
PH and LVSD. The mWHO classification for risk
stratification may require further adaptation and
validation in India.