Outcomes of pregnant patients with cardiac disease at Chris Hani Baragwanath Academic hospital

Abstract

Introduction: The incidence of cardiac disease in pregnancy ranges between 0.1 – 4.0%. It is the 5th leading cause of maternal deaths in South Africa. Management of pregnant cardiac patients involves pre-pregnancy counselling, with risk assessment and monitoring of the mother and fetus by a multidisciplinary team which includes an obstetrician, materno-fetal medicine subspecialist, cardiologist, neonatologist, geneticist and an anaesthetist. Objectives: To determine the maternal morbidity and mortality in cardiac patients presenting at Chris Hani Baragwanath Academic Hospital (CHBAH), as well as their neonatal outcomes and to obtain information about specific cardiac conditions in these patients, their obstetric management and the short-term effects of pregnancy on the underlying cardiac lesion. Methods: This was a prospective descriptive study where post-delivery cardiac patients were approached to enrol in the study from August 2013 to January 2014. Data was collected from the patients’ antenatal records and cardiology reports. Patients were also interviewed to determine more detailed information regarding previous pregnancy outcomes and cardiac complications which were not available in the antenatal records. Neonatal information was obtained by follow-up visits to the neonatal wards. Results: Acquired cardiac conditions accounted for 88.1% of the study patients (Rheumatic Heart Disease (RHD) 42.9% being the most common) while 11.9% were congenital. Most of the patients had a New York Heart Association (NYHA) class of I (85.4%) at antenatal booking. Of the participants in the study, 33.3% were human immunodeficiency virus (HIV) positive. Caesarean section accounted for 66.7% of

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the deliveries while 33.3% were by normal vaginal delivery. There were 42.9% of women who experienced morbidities during their pregnancies with 27.5% suffering a decline in their NYHA class. Only eleven patients had a post-partum ECHO, in whom 82% showed a decline in the ejection fraction (EF). Intrauterine growth restriction (IUGR) complicated 44% of pregnancies. The perinatal mortality rate was 7%. There were no maternal deaths. Conclusion: Rheumatic heart disease is still the predominant underlying cardiac lesion. There is considerable maternal morbidity and perinatal morbidity and mortality in cardiac patients at CHBAH. The multidisciplinary team approach is improving the maternal and perinatal outcome in pregnant women with heart disease at CHBAH.