Heart failure in pregnancy: Risk factors, management, outcomes

Heart failure is relatively rare during pregnancy, a new study has shown. Pre-eclampsia appears to be an important risk factor.

Accessing an electronic hospital database, researchers retrospectively assessed women who had been diagnosed with heart failure and required admission within 42 days postpartum. The study goals were to assess the aetiologies and management of these cases.

Over a scanning period of 13 years totalling 93,122 deliveries, 120 cases of heart failure were detected. The corresponding incidence rate was 0.13 percent, or 1 episode per 776 deliveries. Four patients had more than one episode during the same pregnancy, while one saw one heart failure each in two different pregnancies throughout the study period.

The most common cause of heart failure was pre-eclampsia, seen in 28 percent of cases. This was followed closely by cardiomyopathy (22 percent) and valvular heart disease (18 percent).

Management of heart failure was primarily pharmacological, with agents such as furosemide, metoprolol, and amiodarone, or through respiratory support mainly through oxygen supplementation. Only four patients needed specialist cardiac interventions such as mitral valve replacement and interventional angiography.

Caesarean delivery (CD) was the most common mode of birth in the cohort, performed on 77 percent of patients. Nine patients received general anaesthesia for CD, six of whom did so because of heart failure. Two elective CDs were due to maternal cardiac indications. Most of the women who developed postpartum heart failure also gave birth through CD.

In terms of outcomes, researchers reported that 44 percent of the women were admitted either to the coronary or intensive care unit, and eight percent developed haemorrhage requiring transfusion. There were no deaths. Almost half of the neonates were born prematurely, and 32 percent needed neonatal intensive care.