Scripties UMCG - Rijksuniversiteit Groningen
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Cardiac Disease in Pregnancy: A 1-Year retrospective review of management during pregnancy and maternal and neonatal outcomes from a tertiary hospital in Johannesburg, South Africa

(2019) Balieva, I. (Irina)

Introduction: Cardiac disease in pregnancy contributes to morbidity and mortality for both
mother and child. In South Africa, rheumatic heart disease, repaired or unrepaired congenital
heart disease, hypertensive heart disease and cardiomyopathies are most common. This review
aims at presenting management, outcomes and complications of cardiac disease in pregnancy
in a Black African population in a resource constrained setting.
Methods: A retrospective review of the patient files of all women with cardiac disease
delivering at Charlotte Maxeke Johannesburg Academic Hospital, South Africa, from January
1st – December 31st, 2017 was performed. Descriptive statistics were performed.
Results: The patient files of 75 women were included. Rheumatic heart disease was the most
prevalent diagnosis, followed by congenital heart disease, pulmonary hypertension, and
cardiomyopathies. The mean week of presentation was at 17 weeks of gestation and five women
had no antenatal care appointment prior to delivery. Any cardiac complication was seen in 43
(57.3%) of the patients, of which 24 (55.8%) were a major adverse cardiac event, and 30 (40%)
patients had any obstetric complication. There was one maternal death, two perinatal mortalities
and 11 elective or spontaneous abortions. Prematurity (<37 weeks of gestation) was seen in 23
(36.5%) of the babies.
Conclusion: There was a high rate of cardiac and obstetric complications in this group of
pregnant women in urban South Africa. Most women with cardiac disease can undergo
pregnancy with good outcomes, but a multidisciplinary team is necessary. Late presentation,
high prevalence of comorbidities and socioeconomic factors seem to contribute to poor
outcomes. Pre-conceptual counselling is essential. More research is needed to contribute to
evidence based protocols.

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