Cardiac Disease in Pregnancy - a four-year audit at Pretoria Academic Hospital (2002-2005)

Abstract

Background. Pre-existing medical disease constitutes one of the 5 major causes of maternal death in South Africa. Increasing numbers of women with heart disease are reaching adulthood as a result of advances in diagnoses and treatment of heart disease in childhood.
Objective. To assess the profile of cardiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH).
Methods. A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 to December 2005.
Results. Almost 1% of all patients delivered at PAH had underlying cardiac disease. Most of the cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate, 3.3%. The mean gestational age at delivery was 35 weeks and 18 (9.7%) babies were born before 34 weeks.
Conclusion. Cardiac disease in pregnancy is associated with high morbidity and mortality rates for both mothers and their babies. Multi-disciplinary pre-conceptual evaluation with discussion of risk factors, appropriate family planning and optimising the cardiac state before conception is advised.