Maternal and Neonatal Outcomes in Pregnant Patients with Mitral Stenosis as a Result of Rheumatic Heart Disease

Background: The lack of accurate and timely diagnosis and treatment of mitral stenosis (MS) during pregnancy can lead to irreparable consequences for mother and neonate. The present study aimed to determine maternal and neonatal outcomes of pregnant patients with MS due to rheumatic heart disease. Methods: This prospective cohort study was performed on 35 pregnant women with MS as a result of rheumatic heart disease referred to the prenatal clinic at Shariati Hospital in Tehran in 2015. On first admission, fetal growth status was evaluated with ultrasound and clinical examination. The mothers were also examined in terms of symptoms and complications, and their New York Heart Association functional capacity was determined. The severity of MS was determined using clinical and transthoracic echocardiographic assessments. Results: Maternal mortality and pulmonary edema each occurred in 2.9% of the patients. Termination of pregnancy was required in 17.1%. Mean area of mitral valve was significantly lower in the women with post-delivery complications than in the other women. All the women with post-delivery complications had severe MS, while this defect was revealed only in 53.1% of those without complications (P=0.046). All the neonates delivered as a result of the termination of pregnancy suffered severe MS, whereas this anomaly was detected in 48.3% of the neonates with normal delivery (P=0.044). Conclusions: MS can predict maternal post-delivery events (pulmonary edema and need for mitral replacement therapy) and neonatal complications (termination of pregnancy). The progressive reduction in functional capacity during pregnancy can also predict adverse post-delivery events in patients with MS.