CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 287 and of these, one underwent elective medical termination of pregnancy and two had miscarriages. Twenty-two per cent of these women had a normal vaginal delivery while 75.3% had a caesarean section (C/S) (30.3% were elective C/S deliveries and 45% were emergency C/S deliveries). This was 58.6% (82/140) of the total number of C/S deliveries. There were 60 women in the group with moderate PH, and of these, two had elective medical terminations of pregnancy and one had a miscarriage. Twenty per cent of these women had a normal vaginal delivery while 75% had a C/S (48.3% were elective C/S deliveries and 26.7% were emergency C/S deliveries). This was 32.1% (45/140) of the total number of C/S deliveries. There were 16 women in the group with severe PH, and of these, one had an elective termination of pregnancy and there were no miscarriages; 12.5% of these women had a normal vaginal delivery while 81.3% had C/S deliveries (18.75% were elective C/S deliveries and 62.5% were emergency C/S deliveries. This was 9.3% (13/140) of the total number of C/S deliveries. The overall C/S rate was 78.7%. Elective C/S deliveries accounted for 46.4% (65/140) and emergency C/S deliveries accounted for 53.6% (75/140) (Fig. 3). Among women who had early preterm (< 34 weeks) and late preterm (34–37 weeks) deliveries (n = 97), the majority (37.5 and 43.8%, respectively) were in the group of women with severe PH and the minority (10.1 and 30.3%, respectively) in the group of women with mild PH. Among those who delivered beyond 37 weeks of gestation (n = 81), there were 56.9% in the mild PH group and 12.5% in the severe PH group (p < 0.001). In total, 54.5% (97/178) of women delivered before 37 weeks of gestation and 45.5% (81/178) delivered beyond 37 weeks of gestation (Fig. 4). There were six stillbirths in the cohort, resulting in a foetal loss rate of 3.4%. This left 172 live births in which the birth characteristics were analysed. With increasing severity of PH, the proportions of growth-restricted foetuses increased by 7.8, 17.9 and 28.6% in the categories of mild, moderate and severe PH, respectively, with a total of 12.8% (22/172) of foetuses being growth restricted (p = 0.036). Similarly, as the PH increased in severity, the proportion of low-birthweight (< 2 500 g) babies born increased by 17.4, 45 and 62.5% in the mild, moderate and severe PH groups, respectively. A total of 30.2% (52/172) of foetuses had low birth weight (p < 0.001) (Fig. 5). Table 2. Classification of PH in cohort (n = 185) Groups Number of women Percentage of entire cohort Group 1 24 13.7 Idiopathic 8 4.5 Associated with: Connective tissue disease 2 1.1 Congenital heart disease Patent ductus arteriosus 2 1.1 Tetralogy of Fallot 4 2.3 Ventricular septal defect 4 2.3 Atrial septal defect 2 1.1 Transposition of great arteries 1 0.6 Ebstein’s anomaly 1 0.6 Group 2 151 86.3 Mitral stenosis 33 18.9 Mitral regurgitation 28 16 Mixed mitral valve disease 38 21.7 Aortic valve disease 9 5.1 Mitral and aortic valve disease 1 0.6 Tricuspid regurgitation 4 2.3 Cardiomyopathies 9 5.1 Prosthetic valves 25 14.3 Other 4 2.3 Pulmonary artery pressure Maternal death ICU admission Cardiac failure < 50 mmHg 50–90 mmHg > 90 mmHg Percentage of pregnancies (%) 50 38 25 13 0 0% 8% 0% 3% 12% 20% 25% 44% 50% Fig. 2. Pregnancy outcomes according to severity of maternal PH. Pulmonary artery systolic pressure NVD Total C/S Elective C/S Emergency C/S < 50 mmHg 50–90 mmHg > 90 mmHg Percentage of deliveries (%) 90 68 45 23 0 75% 75% 81% 30% 43% 19% 45% 27% 63% 22% 20% 13% (n = 178) Fig. 3. Mode of delivery according to severity of maternal PH. NVD, non-vaginal delivery; C/S, caesarean section Table 3. Maternal deaths (n = 185) Deaths < 50 mmHg 50–89 mmHg ≥ 90 mmHg Total Alive beyond 42 days, n 109 58 13 179 Maternal death, n (%) 0 2 (3.33) 3 (18.75) 5 Total 109 60 16 185
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