Pregnancy complicated by heart disease in Nepal

Chhetri, Sunit; Shrestha, Ninadini; Pilgrim, Thomas

doi:10.1136/heartasia-2013-010396

Cited by 14 publications

(31 citation statements)

References 10 publications

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“…The consequence of a female preponderance of RHD may be further amplified once girls reach child bearing age because severe valvular damage, particularly mitral stenosis, increases the risk of complications during birth not only for the mother but also for the child. A previous study 42 of 9463 pregnant women documented a prevalence of significant RHD in 5 of 1000 women with a mean age of 25 years. Maternal and fetal or neonatal mortality amounted to 20% among women with a pregnancy complicated by RHD.…”

Section: Discussionmentioning

confidence: 96%

Prevalence of Subclinical Rheumatic Heart Disease in Eastern Nepal

et al. 2016

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Rheumatic heart disease affects 1 in 100 schoolchildren in Eastern Nepal, is primarily clinically silent, and may be more common among girls. The overall prevalence and the ratio of manifest to subclinical disease increase with advancing age, whereas the incidence remains stable at 1.1 per 1000 children per year. Early detection of silent disease may help prevent progression to severe valvular damage.

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Section: Discussionmentioning

confidence: 96%

Prevalence of Subclinical Rheumatic Heart Disease in Eastern Nepal

et al. 2016

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“…Study designs affected the quality and were subject to high levels of bias, especially the case series. Referral and other selection biases as acknowledged in several papers were particularly related to the predominantly single‐site tertiary‐care‐level settings.…”

Section: Resultsmentioning

confidence: 99%

“…However, 18 of the 41 quantitative studies did not specify timing of diagnosis. Others referred to late diagnosis in the context of poorer outcomes and health system shortcomings . Diagnosis during pregnancy/postpartum ranged from 1% to 97% in a longitudinal screening study, with eight studies above 20% and four above 40%.…”

Section: Resultsmentioning

confidence: 99%

“…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%

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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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“…Complications arising from RHD during pregnancy also cause significant morbidity and mortality; in Nepal, pregnant women with RHD had a mortality rate of 4% and foetal and neonatal mortality was 16% [28]. Parks et al [29] measured the mortality of RHD patients in Fiji; the standardized mortality ratio was 8.8 compared with the general population.…”

Section: Introductionmentioning

confidence: 99%