Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland, 1969 to 1978.

Three hundred eighty-seven pregnancies (295 patients) complicated by maternal heart disease, managed at the National Maternity Hospital, Dublin, Ireland, during the years 1969 to 1978, were reviewed. The incidence was 0.5%. Three hundred twenty-three (83.5%) were of rheumatic origin, 52 (13.4%) were congenital, and the remaining 12 (3.1%) were a miscellaneous group and included cases of cor pulmonale and coronary artery disease. There were two maternal deaths--one from congenital heart disease and one from postpartum suicide, unrelated to mild rheumatic heart disease. The perinatal mortality rate was 3.3%. Five pregnancies (three patients) were complicated by surgically uncorrected cyanotic congenital heart disease. One of the maternal deaths and three of the perinatal deaths occurred in this group. There were 38 episodes of cardiac failure (38 patients) in cases of rheumatic heart disease. The New York Heart Association grading was grade 1 in 15 (39%) of these before the onset of failure. Prophylactic antibiotics were not used and infective endocarditis did not occur. Therapeutic abortion was not practiced and a conservative approach was adopted in obstetric intervention and in all drug therapy.