CAUSES OF DEATH IN PREGNANCY WITH HEART DISEASE

Cardiac failure – This is the commonest cause of death. Two types of cardiac failures can occur viz. (i) pulmonary oedema due to left atrial failure, and (ii) congestive failure due to failure of right ventricle. Pulmonary oedema appears with sudden dyspnoesa, cough, expectoration of frothy suptum and even haemoptysis. This is caused by obstruction of tight mitral ring in mitral stenosis; on skiagram, heart often shows normal or slightly enlarged. No severe right ventricular hypertrophy is shown on E.C.G. Acute pulmonary oedema is likely to develop when there are tachycardia as in emotion, exertion and also sudden increase of venous return to the heart following labor. In congestive failure, there appears dyspnoea more insidiously, with evidences of right ventricular failure. The cardiac lesions are those of enlarged heart (more due to right ventricular enlargement), mitral valvular lesions (stenosis with incompetence) and often by atrial fibrillation. This type of failure develops during pregnancy or in labor or after the delivery. The incidence of pulmonary oedema is less frequent than congestive failure but the former is more fatal. Cardiac failures account for about three quarter of all deaths commonly occurring after the delivery; undelivered women commonly die of cardiac failure during 28-32 weeks of pregnancy.