Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 304 AFRICA HF compared to those without peripheral oedema: OR (95% CI) 17.3 (2.6; 115.4). See Table 2 for clinical signs and symptoms on presentation and in late pregnancy. Patients first presenting for antenatal care after gestational week 20 ( n = 20, 27.0%) were more likely to develop HF than those who presented earlier ( p = 0.020). The mWHO class or NYHA FC on presentation did not significantly relate to the development of cardiac complications or combined endpoint. New-onset or newly diagnosed cardiac disease (seen in 46, 62.1%) was related to a higher risk of developing the combined endpoint ( p = 0.038). Women with RHD had a higher risk of developing any cardiac complication ( p = 0.005) than women with other cardiac diagnoses. RHD was significantly related to developing the following complications: PHT ( p = 0.009), arrhythmia needing intervention ( p < 0.001) and blood transfusion ( p = 0.005). The combined endpoint was seen more in women with unoperated RHD than in those who had surgical interventions prior to the pregnancy ( p = 0.016). Any obstetric complication was seen in 30 (40.5%) patients. Ten women (13.5%) had pre-eclampsia, of whom four (40.0%) developed HF, and nine (90.0%) developed pulmonary oedema. There was one (10.0%) elective and one (10.0%) spontaneous miscarriage in the patients with pre-eclampsia. Of the remaining eight babies, five (62.5%) were born prematurely. Patients with HHD had a higher risk of developing pre-eclampsia (10-fold) and pulmonary oedema (eight-fold) compared with those with other cardiac diagnoses: OR (95% CI) 10.9 (1.9; 60.8) and 8.0 (0.5; 140.8). Any cardiac complication and combined endpoint were both more common in patients who developed pulmonary oedema secondary to pre-eclampsia than those without pulmonary oedema: OR (95% CI) 3.4 (0.8; 14.9) and 3.8 (0.9; 16.0), respectively. Caesarean section was the most common mode of delivery ( n = 42, 66.7%) (Table 6). Table 3. Cardiac diagnosis and cardiac medication use Cardiac diagnosis Number (%) Acquired heart disease 62 (83.4) Rheumatic heart disease 21 (28.4) No intervention 12 (57.1) Mixed valve disease 6 (28.6) Mitral stenosis 3 (14.3) Mitral regurgitation 2 (9.5) Aortic regurgitation 1 (4.8) Intervention 9 (42.9) Prosthetic metallic valve replacement 7 (33.3) Valve repair (ring) 1 (4.8) Balloon valvuloplasty during pregnancy 1 (4.8) Rheumatic heart disease and pulmonary hypertension 4 (19.0) Pulmonary hypertension 13 (17.6) Secondary to thromboembolic disease 6 (46.2) HIV-positive patients 3 (50.0) Idiopathic 4 (30.8) HIV-positive patients 0 (0.0) Secondary to left heart disease 2 (15.4) Secondary to intrinsic lung pathology 1 (7.7) Cardiomyopathy 10 (13.5) Peripartum 8 (80.0) Current pregnancy 1 (12.5) Previous pregnancy 7 (87.5) Idiopathic dilated 2 (20.0) Dilated cardiomyopathy with pulmonary hypertension 1 (50.0) Hypertensive heart disease 6 (8.1) Hypertensive heart disease with pulmonary hypertension 1 (1.4) Systemic disease 5 (6.8) Takayasu arteritis 3 (60.0) Systemic lupus erythematosus 2 (40.0) Arrhythmia 3 (4.1) Supraventricular tachycardia 2 (66.7) Extrasystoles with indication for pacemaker (patient refused) 1 (33.3) Mitral valve disease 3 (4.1) Likely secondary to HIV and antiretroviral therapy 2 (66.7) Unknown aetiology (no history of rheumatic fever) 1 (33.3) Congenital heart disease 12 (16.2) Ventricular septal defect, isolated 4 (5.4) No intervention 3 (75.0) Restrictive ventricular septal defect 2 (66.7) Non-restrictive ventricular septal defect 1 (33.3) Surgically repaired 1 (25.0) Ventricular and atrial septal defect, surgically repaired 1 (1.4) Aortic valve replacement (metallic) and ventricular septal defect, repaired 1 (1.4) Sinus of Valsalva aneurysm and ventricular septal defect, no intervention 1 (1.4) Tetralogy of Fallot, surgically repaired 2 (2.7) With residual mixed pulmonary artery disease 1 (50.0) With residual mild pulmonary hypertension and mild tricuspid regurgitation 1 (50.0) Pulmonary valve stenosis, no intervention 1 (1.4) Aortic valve repair 1 (1.4) McCloud’s syndrome 1 (1.4) Table 3. continued Cardiac medication use Number (%) Cardiac medication used at presentation ACE inhibitor* 11 (14.9) Acetylsalicylic acid 2 (2.7) Beta-blocker Atenolol* 3 (4.1) Carvedilol 5 (6.8) Calcium channel blocker 5 (6.8) Furosemide 8 (10.8) Other diuretics 4 (5.4) Spironolactone* 8 (10.8) Statin* 1 (1.4) Warfarin* 11 (14.9) Dose used > 5 mg/day 7 (63.6) Other anti-hypertensive medication 8 (10.8) Cardiac medication started during pregnancy ACE inhibitor* 3 (4.1) Acetylsalicylic acid 6 (8.1) Anti-arrhythmic medication 3 (4.1) Beta-blocker Atenolol* 3 (4.1) Carvedilol 4 (5.4) Calcium channel blocker 6 (8.1) Enoxaparin 38 (51.4) In patients presenting on warfarin 11 (28.9) In patients not on anticoagulation at presentation 27 (71.1) Furosemide 23 (31.1) Other diuretic 3 (4.1) Other antihypertensive medication 12 (16.2) ACE inhibitor, angiotensin converting enzyme inhibitor; HIV, human immuno- deficiency virus. *Medication not recommended for use in pregnancy