EVALUATION OF RISK SCORES FOR PREDICTING MATERNAL COMPLICATIONS IN PREGNANT CARDIAC PATIENTS IN AFIC-NIHD.WHO VS CARPREG SCORE

Abstract

Objective: To report cardiac complications during pregnancy in pregnant patients with cardiac disease and to evaluate suitability and validity of risk scores to predict maternal complications.

Study design: Prospective cohort study

Place and Duration of Study: This study was conducted at obstetrics and gynecology ward of Armed Forces Institute of Cardiology and National Institute of Heart Disease (AFIC-NIHD) from Jan 2015 Dec 2015.

Material and Methods: All consecutive cardiac patients becoming pregnant were enrolled. Risk scoring was done on first visit according to CARPREG scoring and WHO scoring. Patients were followed up for the duration of pregnancy and purperieum. Primary outcome was maternal mortality and morbidity due to cardiac complications. Validity of risk scores was assessed by sensitivity and specificity in predicting complications

Results: A total of 170 patients were enrolled. Mean age was 28.9±4.9 yrs. There were 157(92%) completed pregnancies and 13(8%) miscarriages. Cardiac events complicated 66 (38.8%) of pregnancies and there were 11(6.4%) obstetric and 63(37%) neonatal complications. Cardiac maternal deaths were 04(2.4%) and there were no obstetric deaths. Prediction of cardiac complications by both the scoring systems was significant. The
discriminatory power of each risk score was assessed by the area under the receiver-operating characteristics curve (ROC). AUC 0.746 to WHO modified and AUC 0.651 to CARPREG score.

Conclusion: The modified WHO risks score is better adjusted to predict cardiac complications than CARPREG risk score in our population of pregnant patients with heart disease.