Severe morbidity and mortality associated with cardiac disease during pregnancy in the Free State public health service
| dc.contributor.advisor | Cronje, H. S. | |
| dc.contributor.advisor | Ratnam, S. S. | |
| dc.contributor.author | Schoon, Marthinus Gerhardus | |
| dc.date.accessioned | 2018-02-21T09:53:37Z | |
| dc.date.available | 2018-02-21T09:53:37Z | |
| dc.date.issued | 2000-11 | |
| dc.description.abstract | English: Cardiac disease in pregnancy is an important component of maternal mortality. No good population based study on the extent of cardiac disease in pregnancy has, as yet, been published. A previous study conducted at this institution aimed to describe the morbidity and mortality of cardiac disease in pregnancy, but no guidelines to define morbidity in these cases were available. In 1999 a model was published by Mantel and eo-workers to define acute morbidity as organ dysfunction or failure that will lead to death without treatment. The aim of this study was to describe cardiac disease in a specific population by utilising this model and to try to determine the impact of the disease on the health system. From 1 January 1997 to 31 December 1998 all the available information of patients who presented with cardiac disease was documented. A research assistant was responsible to ensure that the completed hospital records of all the patients who were managed in Health Regions A and B of the Free State Province was available for evaluation. Ward registers and cardiac sonar reports in the regional and tertiary care hospitals (Pelonomi and Universitas) were also scrutinised to ensure that al possible cases were included. All cases with severe acute morbidity according to the Mantel criteria were classified as complicated. The information of the patients was also stratified as either part of the index population if they resided in Regions A or B (the population that was specifically targeted) or as the referred population if they lived in one of the other Regions and were referred to one of the two hospitals. During the 2-year study period 67 patients with cardiac disease were treated. In the study population there were 42 cases (prevalence of 0.12% of all deliveries in 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%) occurred which comprised 11.7 /100 000 deliveries in Regions A and B. Patients with valvular disease had predominantly mitral valve disease. Mitral regurgitation was the most common lesion, single or in combination with other lesions. Patients with mitral stenosis who were managed with beta-blockers developed less lung oedema. There were only five patients who had prosthetic valves of whom one (20%) died. This dramatic decrease in numbers compared to our previous report is probably due to an aggressive attempt to prevent pregnancies in this group of patients. As reported in the rest of Africa, cardiomyopathy was the most common lesion. It occurred in 1:4000 deliveries that took place in Regions A and B. Hypertension was present in 48% of these women. Only one case with a congenital abnormality and two cases with pericarditis were reported. The most expensive group to treat were those cases who were categorised according to the applied model as complicated cardiac disease. They also had significantly less specialist visits compared to the uncomplicated cases. The proposed model of acute morbidity is useful to evaluate cardiac disease in pregnancy 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 is expensive and communities should be informed of the advantages of antenatal care. Women with cardiac disease in pregnancy need specialist expertise and should preferably be evaluated and counselled prior to the onset of pregnancy. | en_ZA |
| dc.description.abstract | Afrikaans: Hartsiekte in swangerskap vorm 'n belangrike deel van moederlike sterfes. Daar is egter geen goeie populasiestudies wat die omvang van hartsiekte in swanger vroue beskryf nie. 'n Vorige studie aan hierdie inrigting het 'n poging aangewend om die morbiditeit en mortaliteit van hartsiekte in swangerskap te beskryf. Daar bestaan egter geen goeie riglyne oor hoe om morbiditeit te beskryf nie. Die beste model is in 1999 deur Mantel en medewerkers gepubliseer met 'n beskrywing van akute morbiditeit as orgaandisfunksie of -versaking wat tot sterfte sal lei indien daar geen behandeling toegepas word nie. Die doel van hierdie studie was om hartsiekte te beskryf in 'n gegewe populasie na aanleiding van hierdie model en 'n poging aan te wend om die impak van die siekte op gesondheidsorg te bepaal. Vanaf 1 Januarie 1997 tot 31 Desember 1998 is alle beskikbare inligting oor pasiënte wat presenteer met hartsiektes gedokumenteer. 'n Navorsingsassistent het verseker dat alle moontlike gevalle wat in die Vrystaat Provinsie se Gesondheidsstreke A en B behandel was, se volledige hospitaalrekords vir beoordeling beskikbaar was. Die saalregisters en hartsonarverslae in die streekshospitaal en tersiêre hospitaal (Pelonorni en Universitas) is ook nagegaan om te verseker dat alle moontlike gevalle ingesluit is. Alle gevalle met erge akute morbiditeit volgens die Mantel kriteria is as gekompliseerd geklassifiseer. Die inligting van die pasiënte is ook gestratifiseer as deel van die indekspopulasie indien hul woonagtig was in Streke A of B (die populasie wat spesifiek ondersoek is) of as die verwysde populasie indien hulle buite Streke A of B woonagtig was en na een van die twee hospitale verwys is. Gedurende die twee jaar is 67 pasiënte met hartsiekte behandel. In die studiepopulasie was daar 42 gevalle (prevalensie van 0.12% van alle geboortes in Streke A en B) waarvan 31 (74%) gevalle gekompliseerd en 11 (26%) ongekompliseerd was. Rumatiese hartsiekte het in 14 (33%) van die gevalle voorgekom terwyl kardiomiopatie verantwoordelik was vir die meerderheid (23, 54%) van die gevalle. Daar was vier moederlike sterftes (9%) wat 11.7 I 100 000 van die bevallings in Streke A en Buitmaak. Pasiënte met klepsiekte het hoofsaaklik mitraalklepaantasting gehad. Mitraalinkompetensie was die mees algemene letsel beide alleen of in kombinasie met ander letsels. Pasiënte met mitraalstenose op betablokkers het minder longedeem ontwikkel. Daar was slegs vyf pasiënte wat voorheen 'n klepvervanging gehad het, waarvan een (20%) gesterf het. Hierdie is 'n dramatiese verlaging sedert die vorige studie en waarskynlik te wyte aan 'n aggressiewe poging om swangerskappe in hierdie groep te voorkom. Soos elders in Afrika was kardiomiopatie die mees algemene afwyking. Die voorkoms was 1:4000 bevallings in Streke A en B. Hipertensie was teenwoordig in 48% van hierdie pasiënte. Daar was slegs een geval met 'n kongenitale hartafwyking en twee wat perikarditis ontwikkel het. Die groep pasiënte wat volgens die toegepaste model as gekompliseerde hartsiekte gedefinieer is, was duidelik die groep wie se behandeling die meeste gekos het. Hulle het ook aansienlik minder spesialisbesoeke gehad. Die voorgestelde model van akute morbiditeit is baie nuttig om hartsiekte in swangerskap te evalueer en om die behandeling van pasiënte te monitor. Spesialisbesoeke verminder die voorkoms van komplikasies en moet aangemoedig word. Pasiënte met hartsiekte wat nie voorgeboortesorg kry nie, kos die staat baie geld en gemeenskappe moet ingelig word oor die voordele van kliniekbywoning. Vroue met hartsiekte in swangerskap benodig spesialiskundigheid en moet verkieslik reeds voor aanvang van die swangerskap volledig evalueer word en voldoende berading ontvang. | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11660/7847 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Pregnancy | en_ZA |
| dc.subject | Near-miss | en_ZA |
| dc.subject | Morbidity | en_ZA |
| dc.subject | Mortality | en_ZA |
| dc.subject | Mitral valve | en_ZA |
| dc.subject | Cardiomyopathy | en_ZA |
| dc.subject | Valve prosthesis | en_ZA |
| dc.subject | Pulmonary hypertension | en_ZA |
| dc.subject | Lung oedema | en_ZA |
| dc.subject | Cardiac output | en_ZA |
| dc.subject | Heart -- Diseases | en_ZA |
| dc.subject | Pregnancy -- Complications | en_ZA |
| dc.subject | Thesis (Ph.D. (Obstetrics and Gynecology))--University of the Free State, 2000 | en_ZA |
| dc.title | Severe morbidity and mortality associated with cardiac disease during pregnancy in the Free State public health service | en_ZA |
| dc.type | Thesis | en_ZA |