Heart disease in pregnancy—evaluation of disease pattern and outcome in Sri Lanka

Introduction: Heart disease complicating pregnancy is a leading cause of maternal morbidity and mortality in Sri Lanka. Understanding the pattern and outcomes of heart disease complicating pregnancy will help to optimise the care.Objective: Describe maternal and fetal outcomes of heart disease complicating pregnancy in a tertiary care unit from 2013 to 2017.To compare the pattern of heart disease complicating pregnancy over the years from the same unit to assess whether there is a change in the pattern of cases presenting in pregnancy.To study the reasons for termination of pregnancy in patients with cardiac disease during the study period Method: Retrospective analysis of secondary data collected from clinical notes of pregnancies complicated with heart disease.Results: A total of 248 cases with diagnosis of cardiac disease complicating pregnancy were included in the study.15 patients had termination of pregnancy in the first trimester due to severe heart disease. Two hundred thirty three (233) patients continued the pregnancy until the delivery. Out of these 233, heart disease was diagnosed during the index pregnancy in 18.9% (n-44) of the patients. Heart disease was categorised as acquired (47.2%), congenital (28.2%), mitral valve prolapse (15%), cardiac arrhythmias (9.4%). Among acquired heart disease 89% was rheumatic in origin. Mitral valve (89.7%) was the commonest valve affected amongst women with rheumatic carditis (n=98). Cardiac decompensation at delivery occurred in 7.7%. Pulmonary hypertension was present in 22.9% with acquired heart disease and 31.7% with congenital heart disease. Three intra uterine fetal demise and two maternal deaths occurred during this period. Conclusion:Rheumatic heart disease remains the commonest heart disease in pregnant women in Sri Lanka. There is an increase proportion of women with congenital heart disease. A significant number required therapeutic termination which highlights the need for improved pre-pregnancy preparation.

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“…The incidence of heart disease complicating pregnancy in the present series was 0.95% compared to 1.46% in the same unit from 1989-1992 6 .…”

Section: Discussioncontrasting

confidence: 55%

“…Rheumatic heart disease remains the commonest type of acquired cardiac disease complicating pregnancy according to the current as well as the previous studies conducted in Sri Lanka 5,6 . In the present study 42.06% (n=98) of patients had rheumatic heart disease compared to 70% in the same unit during the period 1989-92 6 .…”

Section: Discussionmentioning

confidence: 69%

Maternal heart disease and pregnancy outcome: Experience of a single unit in a tertiary care hospital in Sri Lanka

Kaluarachchi

Senanayake

Wjeyaratne

et al. 2020

Sri Lanka J Obstet & Gynae

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“…Poorer maternal and fetal outcomes were associated with higher risk scores (NYHA > II, NYHA > I with mitral stenosis, mWHO > 1, CARPREG/modified CARPREG > 0, or study‐specific factors such as mitral stenosis and anticoagulation therapy leading to increased maternal risks of heart failure, pulmonary hypertension, thromboembolic episodes, atrial fibrillation, and death). The CARPREG index underestimated cardiac events in low‐risk women but overestimated it in CARPREG > 0 in one study, possibly reflecting late diagnoses in pregnancy .…”

Section: Resultsmentioning

confidence: 99%

“…Nine referred to discussion with women in the context of complex decisions surrounding choice of regimen which balanced the maternal risk of thromboembolism using low molecular weight heparin against the increased fetal risk of warfarin use. Studies discussed late booking affecting the anticoagulation regimen with lack of adherence to protocol (or access to treatment) detailed as an important risk factor for morbidity and mortality . Warfarin embryopathy/fetopathy was likely underestimated in studies where postmortems or detailed examinations were not performed…”

Section: Resultsmentioning

confidence: 99%

Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

Vaughan

Dawson

Peek

et al. 2019

Birth

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Background Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence‐based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. Methods A search of 13 databases was supported by hand‐searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. Results The 43 included studies were predominantly conducted in tertiary care centers of low‐income and middle‐income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Conclusions Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole‐of‐life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.

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“…The incidence of maternal heart disease in Sri Lanka is about 1.5 per hundred deliveries. About 70% are of rheumatic origin [1]. It causes chronic valvular lesions commonly affecting the mitral and aortic valves.…”

Section: Its Risks Are Much Less Than Those Of Surgery or Continuing mentioning

confidence: 99%

Percutaneous interventions in stenotic valvular heart disease complicating pregnancy

Senaratne

2011

Ceylon Med. J.

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Heart disease in pregnancy—evaluation of disease pattern and outcome in Sri Lanka

Cited by 6 publications

References 21 publications

Maternal heart disease and pregnancy outcome: Experience of a single unit in a tertiary care hospital in Sri Lanka

Maternal heart disease and pregnancy outcome: Experience of a single unit in a tertiary care hospital in Sri Lanka

Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

Percutaneous interventions in stenotic valvular heart disease complicating pregnancy

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