Severe morbidity and mortality associated with cardiac disease during pregnancy in the Free State public health service

[摘要] English: Cardiac disease in pregnancy is an important component of maternal mortality. Nogood population based study on the extent of cardiac disease in pregnancy has, asyet, been published. A previous study conducted at this institution aimed todescribe the morbidity and mortality of cardiac disease in pregnancy, but noguidelines to define morbidity in these cases were available. In 1999 a model waspublished by Mantel and eo-workers to define acute morbidity as organ dysfunctionor failure that will lead to death without treatment.The aim of this study was to describe cardiac disease in a specific population byutilising this model and to try to determine the impact of the disease on the healthsystem.From 1 January 1997 to 31 December 1998 all the available information of patientswho presented with cardiac disease was documented. A research assistant wasresponsible to ensure that the completed hospital records of all the patients whowere managed in Health Regions A and B of the Free State Province wasavailable for evaluation. Ward registers and cardiac sonar reports in the regionaland tertiary care hospitals (Pelonomi and Universitas) were also scrutinised toensure that al possible cases were included.All cases with severe acute morbidity according to the Mantel criteria wereclassified as complicated. The information of the patients was also stratified aseither part of the index population if they resided in Regions A or B (the populationthat was specifically targeted) or as the referred population if they lived in one ofthe other Regions and were referred to one of the two hospitals. During the 2-yearstudy period 67 patients with cardiac disease were treated.In the study population there were 42 cases (prevalence of 0.12% of all deliveriesin Regions A and B) and 31 (74%) were complicated and 11 (26%) uncomplicated.Rheumatic heart disease occurred in 14 (33%) of the cases whilst the majority (23,54%) of the cases had cardiomyopathy. Four maternal deaths (9%) occurredwhich comprised 11.7 /100 000 deliveries in Regions A and B.Patients with valvular disease had predominantly mitral valve disease. Mitralregurgitation was the most common lesion, single or in combination with otherlesions. Patients with mitral stenosis who were managed with beta-blockersdeveloped less lung oedema. There were only five patients who had prostheticvalves of whom one (20%) died. This dramatic decrease in numbers compared toour previous report is probably due to an aggressive attempt to preventpregnancies in this group of patients.As reported in the rest of Africa, cardiomyopathy was the most common lesion. Itoccurred in 1:4000 deliveries that took place in Regions A and B. Hypertensionwas present in 48% of these women. Only one case with a congenital abnormalityand two cases with pericarditis were reported.The most expensive group to treat were those cases who were categorisedaccording to the applied model as complicated cardiac disease. They also hadsignificantly less specialist visits compared to the uncomplicated cases.The proposed model of acute morbidity is useful to evaluate cardiac disease inpregnancy and to monitor progress in the management of these patients.Specialist visits decrease the number of complications and should be encouraged.Management of patients with cardiac disease who did not receive antenatal care isexpensive and communities should be informed of the advantages of antenatalcare.Women with cardiac disease in pregnancy need specialist expertise and shouldpreferably be evaluated and counselled prior to the onset of pregnancy.

[发布机构] University of the Free State