CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 285 A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa S Budhram, P Krishundutt Abstract Objective: The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa. Methods: A retrospective study was undertaken at a statesubsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant. Results: Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23–33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001). Conclusion: Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension. Keywords: pregnancy, pulmonary hypertension Submitted 1/4/22, accepted 14/11/22 Published online 5/12/22 Cardiovasc J Afr 2023; 34: 285–290 www.cvja.co.za DOI: 10.5830/CVJA-2022-061 Pulmonary hypertension (PH) is a rare yet important condition that may complicate pregnancy. The literature, mostly dating back to the 1990s, reports maternal mortality rates of between 30 and 56% in women with PH.1 Poor perinatal outcomes have also been reported, with high rates of preterm delivery, foetal growth restriction, stillbirth and neonatal death.1-3 It is thought that the haemodynamic, anatomical and biochemical changes that accompany pregnancy, delivery and the puerperium render pregnant women less tolerant to the effects of PH,4 predisposing them to morbidity and mortality. Hence it is recommended that pregnancy be avoided in these women, and if it occurs, then a termination should be discussed.5 PH is categorised into five groups based on aetiology: pulmonary artery hypertension (PAH), PH due to left heart disease, PH due to lung diseases and/or hypoxia, chronic thromboembolic PH, and PH with unclear multifactorial mechanisms.6 The literature on pregnancy courses and outcomes in women with PH is limited. A recent international registry reported outcomes of pregnancy in women with PH and showed a muchimproved mortality rate of less than 5% for their entire cohort of 151 women.7 This cohort was made up of women from both high-, and low- and middle-income countries. There is a large disparity in maternal and perinatal morbidity and mortality rates across the globe, with poorer countries bearing greater burdens of adverse outcome for various reasons. The most recent statistics from the World Health Organisation reported the maternal mortality rate in developed economies to be around 12 per 100 000 live births (0.012%), and 239 per 100 000 live births (0.2%) in emerging economies, with large disparities both between and within countries.8 It would therefore be premature to extrapolate findings from the cited study7 to a South African state-subsidised hospital setting. We have chosen to define our population and describe pregnancy courses and outcomes of women with PH in a South African state-subsidised hospital setting to assist with patient information and counselling. Methods This descriptive, retrospective chart review was conducted at the high-risk obstetric unit (HROU) at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal (KZN), South Africa, following ethical approval from the University of KwaZuluNatal’s biomedical research ethics committee (BE 413/18). The HROU at IALCH is a central referral unit providing quaternary-level care to all women at high risk for adverse maternal and/or foetal outcomes. Medical records at IALCH are stored electronically in the hospital information system, Meditec. ICD 10 codes were used to retrieve consecutive records of all women with a diagnosis of PH admitted to the HROU from 1 January 2016 to 31 December 2018. Department of Obstetrics and Gynaecology, Tygerberg Hospital, and Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa S Budhram, MPhil (Maternal Foetal Medicine), samant@sun.ac.za Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa P Krishundutt, MB ChB
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