Maternal mortality due to cardiac disease in Sri Lanka

Abstract

Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths.

Valvular heart disease in pregnancy

“…Rheumatic mitral stenosis is poorly tolerated in pregnancy, and it is the leading cardiac cause of maternal mortality in the developing world. 22 It may be an incidental finding on physical examination, with many women unaware of the condition until the haemodynamic changes of pregnancy precipitate symptoms, usually in the mid-second trimester. They develop exertional dyspnoea and postural symptoms, including orthopnoea and paroxysmal nocturnal dyspnoea.…”

Pregnancy and native heart valve disease

“…Likewise, heart disease emerges as the main indirect (non-obstetric) cause of maternal death in low/middle-income countries once basic maternity services and sufficient infrastructure are in place. However, while deaths from complications of ischaemic heart disease, heart failure and sudden arrhythmic death syndrome are the leading causes of cardiac maternal death in the UK,2 rheumatic mitral stenosis is the single most common cause of cardiac maternal mortality in the developing world 3 4…”

Heart disease in pregnancy

“…Mitral stenosis is usually rheumatic and poorly tolerated in pregnancy, and it is the leading cardiac cause of maternal mortality in the developing world [29]. Although less common in developed countries, it is still seen in the UK, more often in recent immigrants or where there is social deprivation.…”