RHEUMATIC HEART DISEASE IN PREGNANCY: THE REMOTE PROGNOSIS IN PATIENTS WITH "FUNCTIONALLY SEVERE" DISEASE

Abstract

In. more than 700 cardiac clinic patients there were but 2 deaths, both of which were considered to be preventable. The principles of management are: extra rest, especially in the 6th, 7th and 8th months of gestation; weekly visits for all aged 25 years or more; bed rest for the duration of pregnancy for all Class III and IV cardiacs and for those with a history of congestive heart failure; hospitalization for study on the least suspicion of decrease in cardiac reserve; cesarean section for obstetric reasons only. All cases of severe heart disease, seen from 1931 through 1944, were traced to 1952. The 133 patients were divided into 2 groups - those with and those without pregnancies following the one that qualified them for classification as "severe" heart disease. The 2 groups were shown to be comparable as to functional classification, severity of heart disease as judged by 5 criteria, age at entry into the study and the ages at which they lived and died in the follow-up period. The average annual deaths rates were the same for the 2 groups. Life tables showed that 5 women died prematurely, in later pregnancies. All of these deaths were preventable. All analyses indicated that later pregnancies had no effect upon the course of heart disease and that life expectancy is not shortened by repeated pregnancies if the patients survive the pregnancies, which they can, with proper care.