COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease

Background Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths. Purpose To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases. Methods During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients. Results Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19. Conclusions The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination FUNDunding Acknowledgement Type of funding sources: None.

Cardiovascular Diseases in Pregnancy – A Brief Overview

: Even though, there have been many advances in maternal medical care and fertility treatments, the presence of cardiovascular disease has a significant impact on pregnancy. In pregnant women, several heart conditions, such as valvular heart disease, chronic hypertension, congenital heart defects and non-ischemic cardiomyopathies are linked to increased risk of fetal as well as maternal morbidity and mortality. To date, the management of the co-existing conditions of pregnancy and heart disease has been challenging. Therefore, an in-depth information may be beneficial to tackle a difficult case-scenario. Towards this end, this paper provides an overview of the recent updated knowledge of pregnancy-related cardiovascular diseases in women.

Prospective analytical study on acute pulmonary edema in obstetric intensive care unit

Background: Acute pulmonary oedema is an uncommon,but life threatening event in pregnancy. It causes significant morbidity and mortality due to pathophysiology of pre‐eclampsia and physiological changes of pregnancy which may aggravate certain pre-existing heart disease.Methods: This study was conducted to describe the clinical and epidemiological profile of antenatal women with acute pulmonary edema in obstetric ICU from January 2017 to December 2018 (2 years) in Mahathma Gandhi Memorial Government Hospital, Trichy, Tamil Nadu, India.Results: Acute pulmonary edema (n=31) accounts for 2.7% of ICU/HDU admissions in the study period. Most common etiology observed was severe preeclampsia (12 cases) followed by cardiogenic pulmonary edema (11 cases). Fluid overload, sepsis accounted for 7 cases and one mother with preexisting RHD had severe pre-eclampsia with acute pulmonary edema.Conclusions: Hypertensive disorders of pregnancy and heart disease contributes to major proportion of acute pulmonary edema in this study and it is imperative to recognize signs of critical illness. Skilled multidisciplinary teamwork plays an important role in optimizing maternal and fetal health.