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Title: Heart disease in pregnancy
Author: Haig, David Cameron
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1950
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A review of the work of the past twenty years in the Cardiac Clinic attached to the Royal Simpson Maternity Pavilion of the Royal Infirmary of Edinburgh and a follow -up examination of all cases that had attended this Clinic in the second ten -year period, were carried out. The incidence of organic heart disease was determined to be about 1 per cent of all pregancies and the mortality rate in the last few years to be just under 2 per cent. Considerable reduction in the death rate had occurred over the period of years and the reasons for this were discussed. One of main factors to be a reduction in the number of cases delivered by Caesarean Section and it was shown that the mortality rate following Caesarean Section was roughly twice that following Pelvic delivery in similar groups of cases. The complications and causes of death in cardiac cases during pregnancy were analysed and discussed. The most important single factor was the development of congestive heart failure and means of reduc ing the incidence of this and other complications were discussed. The majority of deaths occurred in the puerperium usually within one day of delivery and it was concluded that the /mor tal ity 14S. mortality rate had been reduced and further reduction could be possible by better and earlier selection of cases as to their fitness to proceed with pregnancy, better ante -natal care with the use of absolute bed -rest when necessary, the prevention and early treatment of the complications liable to occur during preiancy and a policy of "non- intervention" in cases showing, or having shown, congestive heart failure. It was concluded, o n all the available evidence, that Caesarean Section I was not the method of choice and was not indicated in cardiac patients unless there was some other obstetrical reason for carrying it out. On re- examination of the cases it was { found that 10 per cent of those regarded as cardiaca during pregnancy had in fact no organic heart disease. These cases were discussed in detail and it was concluded that in certain women, for some reason as yet unknown, apparent cardiac failure can occur during pregnancy. The most likely explanation was residual myocardial damage o rheumatic origin, but no definite proof could be given. Acute sudden failure may also occur in women with normal hearts during or immediately after labour and the reasons for this were discussed. Of those who had definite organic heart disease during pregnancy 95 per cent had rheumatic heart disease the next most important group being composed of congenital lesions. The difficulty in /diagnosing...... 149. diagnosing organic heart disease during pregnancy was discussed and it was concluded that in some cases it was impossible to decide with certainty if an organic lesion were present or not , The main clinical findings that gave rise to a wrong diagnosis having been made, were listed and discussed. It was found that the functional capacity of the heart, as determined by the method of grading which has been used for over twenty years, was the most important factor in assessing prognosis during and after. pregnancy. The relationship between the functional capacity and several other factors was carefully studied and it was concluded that a woman's grade bore no relationship to her past rheumatic history or the type of valvular lesion but did bear some relationship to her age. In assessing prognosis in a pregnancy knowledge of functional capacity in a previous pregnancy gave full information, and Tables of prognosis based on age, and grade in a previous pregnancy were compiled. As to the ultimate effects of childbearing on the life of a woman with heart disease, it was concluded that, provided the pregnancy and puerperium were safely overcome, she had sustained no permanent Irreparable damage. Pregnancy itself might induce congestive heart failure roughly 5 to 7 years before it was due to appear in the normal course of events but with modern selection and ante -natal care it was doubtful if there was really much of an increased risk attributable to pregnancy. Provided the heart remained well compensated the number of pregnancies did not affect the prognosis. It was possible from the statistical analysis to justify the practice of preventing women who had decompensated at any time from having another ! pregnancy, and it was suggested that care should be taken in allowing women in their late thirties or early forties to continue with pregnancy even although they were fairly well compensated. It was concluded therefore that the present methods of dealing with cardiac cases were justifiable and provided these methods were carried out pregnancy would not adversely affect the course of heart disease. In practice it was considered that if a choice can be made, a woman with heart disease should have her children at an early age and have fairly short intervals between pregnancies, and even though the number of pregnancies does not affect the prognosis, it is probably best to limit the family to two or three children.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available