Pregnancy Outcomes in Women With Rheumatic Mitral Valve Disease

Abstract

Although mortality was only 1.9% during pregnancy, ≈50% of the patients with severe rheumatic MS and 23% of those with significant MR developed heart failure during pregnancy. Prepregnancy counseling and considering mitral valve interventions in selected patients are important to prevent these complications.

High Burden of Cardiac Disease in Pregnancy at a National Referral Hospital in Western Kenya

“…The predominance of complicated RHD seen among pregnant women in our study mirrors the disproportionate burden of RHD disease seen among women of reproductive age in SSA, where RHD remains endemic [5,22,29]. Data from the Registry of Pregnancy and Cardiac Disease (ROPAC), the largest registry of pregnant women with cardiac disease globally, illustrates that 55% of women enrolled from LMICs had valvular heart disease, predominantly rheumatic mitral stenosis, and studies from South Africa estimate that RHD accounts 71-84% of all cases of antenatal heart disease [16,18,21,23]. Additionally, more than half of our cases had severe mitral stenosis and/or pulmonary hypertension, both of which can be contraindications to pregnancy [8,11,17].…”

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

“…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.…”

“…Thirty‐six studies specified echocardiographic review during pregnancy, although only four referenced diagnostic criteria . Six studies did not specify RHD diagnosis confirmed by echocardiography, nor its use during pregnancy …”

“…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 .…”

“…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 . The quality of care and avoidable factors associated with near‐miss morbidity was assessed in two papers, whereas others described gaps between guideline recommendations and clinical implementation leading to compromised care …”