A description of management and outcomes of pregnant patients with cardiac disease attending Charlotte Maxeke Johannesburg Academic Hospital in 2015

Abstract

Background: Cardiac disease remains one of the leading causes of maternal morbidity and mortality in both developed and developing countries. There is a paucity of research work into the profile of cardiac disease in pregnancy. This study aims to describe the management and outcomes of pregnant women with cardiac conditions in pregnancy. Methods: This is a cross-sectional study with a retrospective analysis of all pregnant patients with cardiac disease presenting to Charlotte Maxeke Johannesburg Hospital. This study included all pregnant patients with cardiac disease that presented from 1st Jan 2015- 31st Dec 2015 to Charlotte Maxeke Johannesburg Academic Hospital. Results: The study included a total of 55 pregnant patients who had underlying cardiac disease. One patient was referred for medical termination of pregnancy and there was one miscarriage before 20 weeks of gestation. There were two maternal deaths with a case fatality rate of 3.6%. The distribution of cardiac disease was as follows: Rheumatic heart disease 23.6%, congenital heart disease 29.1%, prosthetic valves 12.7%, cardiomyopathies 20%, Cor pulmonale 3.6%, cardiac arrhythmias 5.5%, hypertensive heart disease 3.6%, and previous cardiac device implants 1.8%. The average gestational age was 37.8 weeks and caesarean section rate was 52.7%. The average birth weight was 2708 grams. Conclusion: Cardiac disease in pregnancy still poses one of the biggest challenges to peripartum morbidity and mortality. The profile of heart disease in these patients show that congenital disease and rheumatic heart disease are the top two causes of cardiac disease in pregnancy. The prevalence of rheumatic heart disease in pregnancy is in keeping with the high prevalence of rheumatic heart disease in developing countries. The rise of congenital heart disease in pregnancy is a reflection of better care for patients born with congenital heart disease allowing them to reach the reproductive age.