Profile of cardiac patients who delivered at Universitas Academic Hospital (UAH) in Bloemfontein South Africa: 2012 – 2017
INTRODUCTION: Maternal deaths related to cardiac disease in pregnancy is rising globally. Cardiac disease remains the leading cause of mortality and morbidity in women with medical and surgical conditions in South Africa. Prevalence of cardiac disease in pregnancy ranges between 0.10.9% in South Africa. Pre-existing cardiac disease also contributes to significant perinatal morbidity and mortality. OBJECTIVES: To assess the profile of women with cardiac disease who delivered at UAH, taking into account maternal and perinatal outcomes, and to identify underlying risks. METHODS: A retrospective analysis of 148 files of pregnant women with cardiac disease who delivered at UAH between January 2012 and December 2017 was carried out. Frequencies and percentages were used to summarise categorical data. Medians and percentiles were used to summarise numerical data. The data analysis was generated using the SAS statistical software. RESULTS: There were 3 154 deliveries at UAH during the study period. The prevalence of cardiac disease in pregnancy was 4.7% (n=148), with black women most affected (89.7%). The average age was 27.0 years. The youngest parturient was 16 years old and the oldest 43 years old. The majority of the patients (71.6%) booked antenatal care in the second trimester, with average gestational age at 19.5 weeks. One hundred and six women (71.6%) tested negative for HIV. The study population had an average BMI of 27. The average gestational age at delivery was 36.7 weeks, with 27.3% of the babies born preterm. Twenty-one (15.3%) of these neonates were admitted to the neonatal intensive care unit. There were eight stillborn deliveries with no neonatal deaths reported. The Caesarean section rate was 67.6%. Vaginal deliveries were 32.4% of all deliveries, and 31.9% (15) of these were assisted deliveries. Of the patients with cardiac disease, 85% were New York Heart Association class (NYHA) I and II. Rheumatic heart disease (RHD), congenital heart disease (CHD) and cardiomyopathy was diagnosed in 48.6% (n=72), 24.3% (n=36) and 18.9% (n=28) of cases respectively. Cardiac failure and pulmonary oedema contributed 56% of maternal morbidity. Cardiac failure was indication for 43.8% of intensive care unit admissions. Six deaths were reported, with a case fatality rate of 4.05%. Peripartum cardiomyopathy was the cause of death in five deaths and valve thrombosis in one death respectively. All deaths were NYHA functional class III and IV. CONCLUSION: The prevalence of cardiac disease among pregnant women is increasing, with rheumatic heart disease (RHD) being the leading aetiology. The most significant increase was that of congenital heart lesions. Pregnancies complicated by underlying cardiac disease are associated with maternal and perinatal morbidity.