Cardiac diseases in pregnancy: A 10-year review in a tertiary hospital in South-west Nigeria
English
DOI:
https://doi.org/10.30442/ahr.0602-04-77Keywords:
Cardiac diseases, Heart failure, Peripartal cardiomyopathy, PregnancyAbstract
Background: The superimposition of the morbidity of cardiac diseases on the physiological demands of pregnancy could impact adversely on pregnancy outcomes. Therefore, contemporary information is for appropriate clinical management.
Objective: To determine the management outcomes of cardiac diseases in pregnancy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife.
Methods: A retrospective review of the hospital records of patients with cardiac diseases in pregnancy between January 2006 and December 2015 was conducted. The age, parity, gestational age at admission, NYHA class, clinical diagnosis, the results of investigations, complications of cardiac diseases, and maternal and foetal outcomes were recorded.
Results: There were 33 women with cardiac diseases in pregnancy and 11,352 deliveries within the period, giving an incidence of 2.9 per 1000. Further analysis was based on 24 women with complete records. The mean age of the patients was 29.2±5.5 years. Twenty (83%) of the women were Para 2 or less, while 13 (54%) presented postpartum. The majority of the women (15; 62.5%) had peripartum cardiomyopathy, while 17 (71%) had NYHA Class III or IV disease. Thirteen (54%) women had vaginal delivery. There were four perinatal and two maternal deaths, with a perinatal mortality rate of 166/1,000 total births and maternal mortality ratio of 8,333/100,000 live births.
Conclusion: Cardiac diseases in pregnancy are associated with high perinatal and maternal mortality rates at the OAUTHC, Ile-Ife. However, with early diagnosis and appropriate care, the majority of the patients had a satisfactory clinical outcome. Early presentation and advocacy to improve health-seeking behaviour are recommended.
References
Klein LL, Galan HL. Cardiac disease in pregnancy. Obstet Gynecol Clin N Am 2004; 31: 429–459.
Van Mook WNKA, Peeters L. Severe cardiac disease in pregnancy, Part II: impact of congenital and acquired cardiac disease during pregnancy. Curr Opin Crit Care 2005; 11: 435–448.
Anandaraja S, Kothari SS, Bahl VK. Management of valvular heart disease during pregnancy. Ind Heart J 2005; 57: 101–108.
Lewis G, (Editor): The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer 2003-2005. The 7th Report. London. CEMACH; 2009.
Steer PJ, Gatzoulius MA, Baker P. Heart Disease and Pregnancy. London. RCOG Press. 2006.
Burt CC, Dirbridge J. Management of cardiac disease in pregnancy. Cont. Edu Anaesthesia Crit Care and Pain 2009; 9: 44-47.
Ruys TPE, Roos-Hesselink JW, Hall R, Subirana-Domenech MI, Grando-Ting J, Estensen M, et al. Heart failure in Pregnant women with cardiac disease: data from the ROPAC. Heart 2014; 100: 231-238.
Hammed AB, Montoro MN. Cardiac and Pulmonary Disease in Pregnancy. In: DeCherney AH, Nathan L, Goodwin TM, Laufer N (Editors). Current Diagnosis and treatment in Obstetrics and Gynaecology. 11th Ed. McGraw-Hill Companies. New York. 2013: 465-473.
Karamermer Y and Roos-Hesselink JW. Pregnancy and adult congenital heart disease. Expert Rev Cardiovasc Ther 2007; 5: 859–869.
Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Euro J Heart Failure 2010; 12: 767–778.
Ventura HO. Peripartum cardiomyopathy: clinical and therapeutic characteristics. J La State Med Soc 1991; 143: 45-48.
Desai D, Moodley J, Naidoo D. Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature. Trop Doct 1995; 25: 118-123.
Sanderson JE, Adesanya CO, Anjorin FI, Parry EH. Post-partum cardiac failure: Heart failure due to volume overload. Am Heart J 1979; 97: 613-621.
Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation 1971; 44: 964-968.
Veille JC, Zaccaro D. Peripartum cardiomyopathy: summary of an international survey on peripartum cardiomyopathy. Am J Obstet Gynecol 1999; 181: 315-319.
Mosca L, Benjamin EJ, Berra K, Benzanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: A guideline from the American Heart Association. Circulation. 2011; 123: 1243-1262.
Ramaraj R, Sorrell VL. Peripartum cardiomyopathy: causes, diagnosis, and treatment. Cleveland Clinic J Med 2009; 76; 289–296.
Downloads
Published
Issue
Section
License
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.
