Cardiovascular Journal of Africa: Vol 27 No 2 (March/April 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 2, March/April 2016 AFRICA 117
is usually sufficient to manage symptoms of fluid overload.
Vaginal delivery is the preferred method of delivery, and in those
patients who become symptomatic, epidural anaesthesia and a
shortened second stage is advisable.
Most patients with simple congenital heart lesions (these are
the vast majority attending general cardiology clinics) tolerate
pregnancy well. However, for those patients with more complex
lesions, or those who may be taking teratogenic drugs, the issues
of contraception and planning a pregnancy should be raised as
soon as the young woman reaches childbearing potential.52
Contraceptive options are diverse and the discussion
should be tailored to the individual, taking into account her
underlying medical history as well as her educational and social
circumstances. The practitioner will have to balance efficacy
against safety but it is reasonable that in patients with severe
cardiac disease where pregnancy itself poses an unacceptably
high risk for the mother, then it is probably justified in leaning
towards efficacy in these patients.52
Conclusion
Rheumatic disease is a common and serious complication
of pregnancy in developing countries. Pregnant women
suffering from the sequelae of rheumatic fever benefit from the
combined expertise of specialist cardiologists, obstetricians and
anaesthesiologists during the pregnancy. Undiagnosed disease
may also be identified for the first time during pregnancy, and
the process of delivering obstetric care provides an opportunity
to secure continuity of postnatal care with an emphasis on
preventive therapy and contraception.
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