357. Pregnancy in Cardiac disease – An audit on outcomes in the Joint Cardiac Pregnancy Clinic, Singapore General Hospital.

Introduction Cardiac disease is an increasingly important cause of maternal morbidity and mortality. Joint multidisciplinary care of these pregnancies is strongly advocated. Aim Pregnancy outcomes in cardiac patients seen at the cardiac joint clinic. Method and results All pregnant mothers with acquired or congenital heart diseases are referred to CJC, which is jointly run by consultant obstetricians and cardiologists., with easy access to anaesthesia and neonatal referrals. Delivery was in a tertiary level teaching hospital. 60 new cases were seen from 2009 to 2013. Median maternal age was 29 (19–40). Most had WHO class 1 disease (66.6%) with NYHA status 1 (90%). 10% of the population had WHO class 4 disease but none had a NYHA score worse than 2. Two thirds had congenital heart disease, which 55% were valvular. Acquired heart conditions made up the remaining third of which only 15 % were valvular. The most common cardiac diagnoses include MVP (21.7%), AS/VSD (16.7%) and cardiomyopathy (16.7%). Caesarian sections rate was 59.3% (40% emergency sections) with a median hospital stay of 3 days. Vaginal delivery rates were 40.7% with 16% being assisted. There were no neonatal or maternal mortalities. Patients who developed cardiomyopathy postpartum or have a history of previous or existing cardiomyopathy had longer hospitalisation stays. Median gestational age was 38 + 2 days (32–41 weeks) and median birth weight was 3072.5 g. Median APGAR scores were 8, 9 at 1 and 5 min respectively. Median length of stay for the baby was 4 days with average length of stay being 5.58 days. Conclusion Congenital heart disease remains an important contributing aetiology to cardiac disease in pregnancy. The majority of our patients achieved good maternal and neonatal outcomes, underpinning the importance of providing a seamless joint service providing multi-disciplinary pre-pregnancy, antepartum, intrapartum and postpartum care.