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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 305 Perinatal outcomes There was a total of 62 (83.8%) live births. Prematurity (gestational age < 37 weeks) was seen in 20 (32.3%) neonates, and 10 (16.1%) neonates were small for gestational age (< 10th percentile weight) (Table 6). Women who developed pulmonary oedema secondary to pre-eclampsia had a six times higher risk of prematurely born babies: OR (95% CI) 6.2 (1.1; 35.6). The use of beta-blockers in pregnancy was not related to prematurity or intrauterine growth restriction, but one stillbirth occurred in a mother using atenolol throughout the pregnancy for supraventricular tachycardia. One early neonatal death occurred in a baby delivered at gestational week 28 by an emergency caesarean section due to acute HF in a mother presenting with cardiomyopathy. Of 27 (36.5%) foetal anomaly scans, one (3.7%) showed no foetal heart in a patient using warfarin at conception and the woman had a spontaneous miscarriage at gestational week 23. The remaining foetal scans were normal. The use of anticoagulation at conception was associated with a higher rate of elective abortions ( p = 0.039). Women who presented in mWHO class III or IV had a higher rate of elective or spontaneous abortions ( p = 0.011). Discussion This study shows the prevalence of cardiac disease, its management and the outcomes in pregnant women attending a large public tertiary hospital in urban South Africa. Table 4. Echocardiographic assessment Assessment Echocardio- graphic values Normal values All patients ( n = 73) Ejection fraction (%) first echocardiogram 60 ± 13 > 55 Ejection fraction (%) last echocardiogram 59 ± 12 > 55 LVIDd (mm) 47 ± 8.6 35–51 LVIDs (mm) 33 ± 9.2 20–37 Mean PAP (mmHg) (IQR) 31 (20–45) < 25 Tricuspid annular plane systolic excursion (mm) 22 ± 5.4 > 17 Inferior vena cava diameter (mm) (IQR) 15 (12–19) < 17 Dilated right ventricle, n (%) 15 (20.5) E/a ratio (IQR) 1.6 (1.1–2.1) 0.8–2.0 E/e ′ ratio (IQR) 9.5 (7–12) < 8 Rheumatic heart disease ( n = 21) Ejection fraction (%) 59 ± 11 > 55 Mean PAP (mmHg) (IQR) 30 (19–38) < 25 Patients without intervention Mitral valve stenosis ( n = 8) Mean pressure gradient (mmHg) (IQR) 19 (8–25) < 2 Area across valve (cm 2 ) (IQR) 0.8 (0.7–1.2) 4.0–6.0 Aortic valve stenosis ( n = 1) Valve area, cm 2 1.8 2.5–4.5 Mean pressure gradient (mmHg) 51 < 5 Aortic valve regurgitation ( n = 3) Pressure half-time (ms) ( n = 2) 260 (217–300) > 500 Jet size ratio (%) ( n = 1) 70 < 24 Cardiomyopathy, ( n = 9 with echocardiogram) Ejection fraction (%) first echocardiogram 46 ± 16 > 55 Ejection fraction (%) last echocardiogram 50 ± 13 > 55 LVIDd (mm) 54 (42–76) 35–51 LVIDs (mm) 38 (26–65) 20–37 Left atrium (mm) 35 (30–60) < 40 Tricuspid annular plane systolic excursion (mm) (IQR) 26 (20–28) > 17 Pulmonary hypertension ( n = 13) Ejection fraction (%) 67 ± 6.3 > 55 LVIDd (mm) 45 (39–52) 35–51 LVIDs (mm) 30 (21–32) 20–37 Mean PAP (mmHg) (first measure) (IQR) 48 (34–63) < 25 Mild PHT (mPAP 25–40 mmHg), n (%) 8 (51.5) Moderate PHT (mPAP 41–55 mmHg), n (%) 2 (15.4) Severe PHT (mPAP > 55 mmHg), n (%) 3 (23.1) Mean PAP (mmHg) (last measure) (IQR) 40 (26–80) < 25 Tricuspid annular plane systolic excursion (mm) 22 (9–27) > 17 Inferior vena cava diameter (mm) 18 (15–25) < 17 Hypertensive heart disease, ( n = 7) Ejection fraction (%) (IQR) 52 (43-80) > 55 LVIDd (mm) (IQR) 44 (37–62) 35–51 LVIDs (mm) (IQR) 36 (25–52) 20–37 Left atrium (mm) (IQR) 34 (29–48) < 40 E/a ratio (IQR) 2.1 (1.1–3.1) 0.8–2.0 E/e ′ ratio (IQR) 15.0 (11–16) < 8 Patients with echocardiographic examination, n (%) 73 (98.7) Number of echocardiograms performed per patient, median (range) 2 (0–8) Numbers presented as median and range or interquartile range (IQR), unless otherwise specified. LVIDd/s, left ventricular internal diameter at end-diastole/-systole; mPAP, mean pulmonary artery pressure; PHT, pulmonary hypertension. Table 5. Maternal cardiac complications Cardiac complications Number (%) Heart failure 15 (20.3) Pulmonary hypertension 11 (14.9) Blood transfusion 8 (10.8) Arrhythmia 6 (8.1) Pulmonary embolism 3 (4.1) Hypertensive heart disease 2 (2.7) Any cardiac complication 30 (40.5) Combined endpoint* 21 (28.4) *Combined endpoint: death, heart failure, myocardial infarction, insertion of assist device, surgical cardiac interventions, thromboembolic disease and arrhythmia needing therapy. 17 30 21 30 1 1 Maternal outcomes Intensive care unit admissions Any cardiac complica- tion Combined endpoint* Any obstetric complica- tion Mortality Surgical interven- tion during pregnancy Number of patients 70 60 50 40 30 20 10 0 Fig. 2. Overview of maternal outcomes showing a high rate of cardiac and obstetric complications. *Combined endpoint: death, heart failure, myocardial infarc- tion, surgical cardiac interventions, thromboembolic disease and arrhythmia needing therapy.