Maternal mortality due to valvular heart disease: a population-based study in Turkey

Background/Aim To assess the clinical and demographic features of maternal mortality cases among patients with cardiac valvular diseases between 2012 and 2019. Methods Maternal mortality due to valvular heart disease between January 2012 and December 2019 in Turkey was retrospectively analyzed. The cases were classified according to New York Heart Association (NYHA) classification based on the severity of the heart disease. NYHA classification groups were divided into two; as class I–II ( n = 34) and class III–IV ( n = 31). Two groups were compared in terms of demographic and clinical characteristics. Results Valvular heart disease was diagnosed in 41 (63.1%) of the cases before pregnancy. It was found that 100% ( n = 21) of the warfarin users had switched to low molecular weight heparin treatment due to concerns about warfarin embryopathy after the diagnosis of pregnancy, and only 14.2% ( n = 3) of them had been monitorized with Antifactor Xa activity to evaluate the effectiveness of the medication. Two NYHA groups had similar clinical characteristics. Intensive care unit admission rate, frequency of prosthetic valve, rate of thromboprophylaxis, type of valvular disease and reasons of maternal death were similar between the NYHA groups ( p < 0.05). Conclusion Maternal mortality may be observed in cases with NYHA class I–II in almost similar rates with NYHA class III–IV. Therefore, it is crucial to adequately assess the mortality risk of pregnant women with cardiac valvular pathologies and to achieve early diagnosis and appropriate treatment in order to reduce maternal mortality.