[IDIOPATHIC MYOCARDITIS BEFORE AND AFTER PREGNANCY].
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Between 1955 and 1962, 145 maternal deaths were reported in the Province of British Columbia. One hundred of them were due to obstetrical causes. Of these deaths, hemorrhage was by far the commonest cause (40 cases), followed in frequency by vascular accidents (23 cases), infections (17 cases), toxemia (10 cases), anesthetic deaths (five cases), and other causes (five cases). Significant avoidable factors were noted in 80%. Indirect obstetrical deaths accounted for 29 cases, or 20% of all maternal mortalities. The most frequently encountered causes of indirect obstetrical deaths were cardiac (nine cases) and vascular accidents (six cases). Avoidable factors were considered to be present in 19 of the 29, an incidence of 65%.When all deaths were considered together, 72% were felt to have significant avoidable factors when judged against an academic standard. It was also apparent that some 40% to 50% of deaths were intimately involved with social factors.
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To assess maternal and fetal outcome of pregnancy in patients with congenitally corrected transposition of the great arteries, we reviewed 19 patients (18 retrospectively) who had 45 pregnancies. Their ages ranged from 18 to 40 years (mean 27) at the time of pregnancy. Thirty-six percent of the pregnancies were undertaken while patients were cyanosed, 7% in patients with unpaced complete heart block, and 16% were undertaken after surgical repair of the associated anomalies. Change in functional class and maternal cardiovascular complications during pregnancy were analyzed as well as number of live births, miscarriages, elective termination of pregnancies, timing of delivery, and incidence of cardiac defects in the live offspring. Five patients (26% of patients) developed cardiovascular complications during pregnancy, namely congestive heart failure (3 patients), worsening cyanosis (1 patient), and cerebrovascular accident (1 patient). No maternal deaths occurred. There were 27 live births (60%), 12 miscarriages (27%), and 6 elective terminations of pregnancy (13%). Cyanosis was a significant risk factor for miscarriage. One live offspring had congenital heart disease. Close follow-up of these patients during pregnancy, by a team of experienced physicians, is recommended.