Abstract
Objective: To determine the safety of vaginal delivery in cardiac pregnant women as compared to lower segment cesarean section.
Methods: A case-control study was conducted in Departments of Obstetrics & Gynecology, Yusra Medical & Dental College, Islamabad, Pakistan from January 2008 to December 2009. A total of 176 pregnant women were sampled through purposive sampling technique and interviewed by using pre-tested structured questionnaire. 86 women were taken as cases who had acquired or congenital cardiac diseases and 90 as controls without cardiac problems. Data was collected on demographic features, obstetrical and medical parameters.
Results: Out of 86 cardiac pregnant women, 62 (72%) had spontaneous vaginal delivery (SVD) and 24 (28%) underwent lower segment caesarian section (LSCS) either due to obstetrical or cardiac reasons. In control group, out of 90 noncardiac pregnant women, 78 (87%) had SVD and 12 (13%) had LSCS. In cardiac pregnant women, with SVDs, only 2 (3.2%) had primary post partum hemorrhage (PPH) of milder degree, which was treated with uterine bimanual massage. In LSCS in the cardiac pregnant women, 7 (24%) had primary PPH out of which 3 were treated with simple measure like infusion Syntocinon, Misoprostol rectally, one patient required blood transfusion, one had to undergo hysterectomy due to uncontrollable hemorrhage and one patient had secondary PPH and was treated with antibiotics and blood transfusion.
Conclusion: Vaginal delivery was the safest and preferred route of delivery in pregnant women with cardiac diseases.

Key words: LSCS, Spontaneous vaginal delivery, SVD, PPH, pregnant cardiac patients.