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


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.


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.


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.

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Correspondence to Nekkilady Veni.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed consent

As it was a retrospective study, formal informed consent was not required.


There was no external funding or grants that assisted in the study.

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Dr. C. N. Sheela is a Professor, Department of OBG, HOD (Jan 2013-17) St John’s Medical College, Bangalore. Nekkilady Veni is a MBBS, MD, FMAS, DNB OBSTETRICS AND GYNECOLOGY. Dr. Ponnusamy Vinotha is a Biostatistician Lead 1. Sumithra Selvam is a Senior Resident in Biostatistics.

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Sheela, C.N., Veni, N., Vinotha, P. et al. Validation of the Risk Score for Maternal Cardiac Complications in Women with Cardiac Disease in Pregnancy: A Retrospective Study. J Obstet Gynecol India 69, 399–404 (2019).

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  • Cardiac diseases
  • Pregnancy
  • Risk score
  • Pulmonary hypertension
  • CARPREG score