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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 301 Pregnancy in women with cardiac disease: a one-year retrospective review of management and maternal and neonatal outcomes in a tertiary hospital in Johannesburg, South Africa Irina Balieva, Lawrence Chauke, Amy Wise, Adriaan A Voors, Elise Schapkaitz, Hendrik Lombaard, Haroun A Rhemtula Abstract Introduction: In South Africa, cardiac disease continues to be the most important non-obstetric cause of maternal death. Methods: A record review of 74 pregnant women with cardi- ac disease was performed to determine the prevalence and outcomes of cardiac disease at Charlotte Maxeke Johannesburg Academic Hospital between January and December 2017. Results: Rheumatic heart disease was the most common cardiac diagnosis ( n = 21, 28.4%), followed by pulmonary hypertension ( n = 13, 17.6%) and congenital heart disease ( n = 12, 16.2%). There were one (1.4%) maternal and two (2.7%) perinatal deaths. Neonatal complications included pre-term delivery ( n = 20, 32.3%) and small-for-gestational-age infants ( n = 10, 16.1%). Cardiac complications ( n = 30, 40.5%) included heart failure ( n = 15, 20.3%), pulmonary hyperten- sion ( n = 11, 14.9%) and blood transfusions ( n = 8, 10.8%). Conclusion: Cardiac disease in pregnancy was associated with a high risk of maternal and neonatal complications. Pre-conceptual counselling and managing pregnant women at a dedicated centre by a multidisciplinary team could, however, improve outcomes. Keywords: cardiac disease in pregnancy, rheumatic heart disease, valvular heart disease, anticoagulation in pregnancy, modified World Health Organisation classification Submitted 19/1/20, accepted 23/12/20 Published online 9/2/21 Cardiovasc J Afr 2021; 32 : 301–307 www.cvja.co.za DOI: 10.5830/CVJA-2020-062 Maternal cardiac disease significantly contributes to maternal and neonatal morbidity and mortality. 1-3 In South Africa, cardiac disease was the most common non-obstetric cause of death due to medical and surgical disease in the last triennial report of 2014–16. 3 Pregnancy can exacerbate any pre-existing cardiac disease, or cardiac disease can manifest itself for the first time during or after pregnancy. Physiological haemodynamic changes during pregnancy put extra strain on the heart, and can take several months postpartum to return to the non-pregnant state. 4,5 Physiological signs and symptoms of pregnancy, including shortness of breath, peripheral oedema, fatigue, palpitations and tachycardia, often resemble those of cardiac disease, complicating the diagnostic process. 4,6 The modified World Health Organisation (mWHO) risk classification can be used to estimate the risk of morbidity and mortality from cardiac disease in pregnant women, ranging from low risk of complications (class I) to a pregnancy being contraindicated (class IV). 7 In developing countries, rheumatic heart disease (RHD), hypertensive heart disease (HHD) and, often unrepaired, congenital heart disease (CHD) are commonly seen in pregnancy. 7-10 Peripartum cardiomyopathy (PPCM) is less common but is serious and can be missed as it often presents postpartum. 11 Women with RHD and other valvular disorders requiring mechanical valve replacements will need life-long anticoagulation, complicating management of pregnancy and delivery. 12 The most common neonatal complications related to cardiac disease in pregnancy include pre-term delivery, intra- uterine growth restriction and low birth weight. 10,13-15 Although some reports have been published on the prevalence and consequences of maternal cardiac disease, data on maternal and neonatal outcomes of pregnancy in women with cardiac disease in South Africa vary greatly. 2,16,17 More data on presentation and management are needed to reduce preventable deaths in mothers. This review presents the outcomes of pregnancy in women with cardiac disease. University of Groningen, Groningen, the Netherlands Irina Balieva, MD, irinabalieva@gmail.com Adriaan A Voors, MD, PhD University of the Witwatersrand, Johannesburg, South Africa Irina Balieva, MD, irinabalieva@gmail.com Lawrence Chauke, MSc, MMed, FCOG (SA) Amy Wise, MB BCh, MMed, FCOG, Dip HIV Man, Cert Maternal Foetal Med Elise Schapkaitz, MB BCh, MMed, FCPath (SA) Hendrik Lombaard, MB BCh, MMed, FCOG (SA) Haroun A Rhemtula, MB BCh (Wits), FCOG (SA), MMed (O&G) (Wits) Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa Haroun A Rhemtula, MB BCh (Wits), FCOG (SA), MMed (O&G) (Wits) Lawrence Chauke, MSc, MMed, FCOG (SA) Elise Schapkaitz, MB BCh, MMed, FCPath (SA) Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa Amy Wise, MB BCh, MMed, FCOG, Dip HIV Man, Cert Maternal Foetal Med Hendrik Lombaard, MB BCh, MMed, FCOG (SA) Empilweni Services Research Unit, Johannesburg, South Africa Amy Wise, MB BCh, MMed, FCOG, Dip HIV Man, Cert Maternal Foetal Med Hendrik Lombaard, MB BCh, MMed, FCOG (SA)