COVID-19 Pregnancies with Heart Disease: Challenges of Delivery

Abstract

This case series of four cases of pregnancy with rheumatic heart disease with COVD-19 disease reports on the management of delivery and complications of heart disease with COVID-19, high-lighting the presentation, severity, delivery concerns, and clinical management with the maternal and fetal outcomes. Of the four full-term deliveries, one delivered normally, one instrumental delivery and two by cesarean section. All four required oxygen support post-delivery, 2/4 (50%) were transferred for intensive care unit (ICU) care, 1/4 (25%) required mechanical ventilation, 1/4 (25%) had postpartum hemorrhage, 1/4 (25%) had COVID related sepsis and received convalescent plasma therapy, and 2/4 (50%) received antiviral remdesivir. The most severe disease (COVID sepsis and ICU stay) was seen in patient of heart disease with COVID with preclampsia. All neonates tested SARS-CoV-2 negative, with one early neonatal death. All four mothers were discharged in stable condition of COVID and heart status. COVID-19 in cardiac disease pregnancies has increased rates of complications, oxygen, and ICU requirements than other pregnancies with COVID, requiring multidisciplinary team for intensive monitoring of intrapartum and postpartum period.

Cardio-obstetrics in India: The Mission, the Scope and the Road Ahead

“…These clinics would cater to the needs of preconceptional risk assessment and counseling in patients with cardiac ailments, cardiovascular evaluation and diagnosis during pregnancy, diagnosis and treatment of pregnancy-associated hypertension and preeclampsia, management of native and prosthetic valvular disease, congenital heart disease (naive as well post procedural), cardiomyopathies (peripartum, dilated, and hypertrophic cardiomyopathy), and arrhythmias in pregnancy. [4][5][6][7][8][9][10][11] It would also review methods for fertility control for the patient with cardiac disease and the risk of cardiac drugs during pregnancy and lactation. Moreover, the diagnosis and management of acute catastrophies as deep vein thrombosis and pulmonary embolism during pregnancy, acute myocardial infarction, and spontaneous coronary dissection during pregnancy could have an active involvement of cardio-obstetrics team.…”