BACKGROUND: Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa. METHODS: We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period. RESULTS: Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P=0.03); severe tricuspid regurgitation (P=0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P<0.001). A favourable maternal outcome was associated with: prior cardiac events (P<0.001); prior surgical valve replacement (P=0.03); cardiac prosthetic valve (P=0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28weeks (range, 8-38weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%). CONCLUSIONS: Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis.
BACKGROUND: Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa. METHODS: We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period. RESULTS:Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P=0.03); severe tricuspid regurgitation (P=0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P<0.001). A favourable maternal outcome was associated with: prior cardiac events (P<0.001); prior surgical valve replacement (P=0.03); cardiac prosthetic valve (P=0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28weeks (range, 8-38weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%). CONCLUSIONS:Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis.
Authors: Liesl Zühlke; Mark E Engel; Ganesan Karthikeyan; Sumathy Rangarajan; Pam Mackie; Blanche Cupido; Katya Mauff; Shofiqul Islam; Alexia Joachim; Rezeen Daniels; Veronica Francis; Stephen Ogendo; Bernard Gitura; Charles Mondo; Emmy Okello; Peter Lwabi; Mohammed M Al-Kebsi; Christopher Hugo-Hamman; Sahar S Sheta; Abraham Haileamlak; Wandimu Daniel; Dejuma Y Goshu; Senbeta G Abdissa; Araya G Desta; Bekele A Shasho; Dufera M Begna; Ahmed ElSayed; Ahmed S Ibrahim; John Musuku; Fidelia Bode-Thomas; Basil N Okeahialam; Olukemi Ige; Christopher Sutton; Rajeev Misra; Azza Abul Fadl; Neil Kennedy; Albertino Damasceno; Mahmoud Sani; Okechukwu S Ogah; Taiwo Olunuga; Huda H M Elhassan; Ana Olga Mocumbi; Abiodun M Adeoye; Phindile Mntla; Dike Ojji; Joseph Mucumbitsi; Koon Teo; Salim Yusuf; Bongani M Mayosi Journal: Eur Heart J Date: 2014-11-25 Impact factor: 29.983