Validation of the Risk Score for Maternal Cardiac Complications in Women with Cardiac Disease in Pregnancy: A Retrospective Study

C N Sheela; Nekkilady Veni; Ponnusamy Vinotha; Selvam Sumithra

doi:10.1007/s13224-019-01226-2

Validation of the Risk Score for Maternal Cardiac Complications in Women with Cardiac Disease in Pregnancy: A Retrospective Study

J Obstet Gynaecol India. 2019 Oct;69(5):399-404. doi: 10.1007/s13224-019-01226-2. Epub 2019 Apr 22.

Authors

C N Sheela¹, Nekkilady Veni², Ponnusamy Vinotha³, Selvam Sumithra⁴

Affiliations

¹ 1St. John's Medical College, No. 562, 1st Cross, K G Layout, BSK 3rd Stage, 3rd Phase, Bangalore, 560085 India.
² 2MS Ramaiah Medical College, No. 5, 2nd A Cross, Suraveena, Near Jayadurga Kalyana Mantap, J C Nagar, Mahalaxmipuram, Bangalore, 560086 India.
³ 3Covance India Pharmaceutical Services Private Limited, Shivajinagar, Bangalore, Karnataka India.
⁴ 4St. John's Research Institute, Bangalore, India.

Abstract

Aim of the study: To validate the new cardiac risk scoring system, Sheela's Cardiac Disease in Pregnancy (SHE-CDIP), in predicting the cardiac complications in women with cardiac disease in pregnancy.

Materials and methods: The study was conducted at a tertiary care hospital in South India, over a period of 5 years from January 2010 to January 2015. Pregnant women with heart disease included in this study were 102, and data was collected from medical records. Risk Score was calculated at booking according to both the new scoring system (SHE-CDIP) and the standard CARPREG scoring system. The validation was done by assessing the ability of the new scoring system to predict maternal cardiac complications by comparing with the CARPREG scoring system.

Statistical methods: The validation of the SHE-CDIP score was done against CARPREG score using cross tabulation between current cardiac risk score with CARPREG score. McNemar square test was done to compare the proportion between two scoring methods. Agreement between CARPREG and SHE-CDIP risk score was analyzed using Kappa statistics, and accuracy was reported.

Results: Comparing the two risk scores using Kappa statistics, accuracy and good agreement were noted (kappa = 0.70). Sensitivity of 83%, specificity of 88%, positive predictive value of 86% and negative predictive value of 84% for the SHE-CDIP scoring system were noted.

Conclusion: The new risk score (SHE-CDIP) would be useful to stratify the risk in Indian cohort of women with cardiac disease in pregnancy as it is population specific.

Keywords: CARPREG score; Cardiac diseases; Pregnancy; Pulmonary hypertension; Risk score.