Abstract
Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries. To minimize the effects of CVD in pregnancy, proper risk assessment and appropriate referral is required. In Sri Lanka, cardiovascular disease complicating pregnancy is a significant cause of maternal mortality, second only to postpartum hemorrhage. Screening for CVD in pregnancy in Sri Lanka is limited to a routine clinical assessment. Evidence-based guidelines are yet to be developed, and this deficit may have resulted in a substantial underestimation of the CVD burden. This study aims to determine the burden of CVD in early pregnancy and develop a risk prediction model to be used in field pregnancy clinics in Sri Lanka to reduce CVD effects in pregnancy. A prospective cohort study was carried out in the Anuradhapura district, Sri Lanka. Following registration to the antenatal care, pregnant women fulfilling the eligibility criteria were invited to attend a special clinic at their relevant Medical Officer of Health (MOH) area. Risk assessment was done through history and a clinical examination, and suspected/probable cases were referred for an echocardiogram by a consultant cardiologist. All the recruited participants in the first trimester were prospectively followed up and screened again between 24-28 weeks of the period of amenorrhoea (POA). Antenatal ward admissions with CVD complicating pregnancy will be extracted, and a telephone interview will be carried out between 6-12 weeks after the expected delivery date to cover postpartum morbidities. This proposed study will be the largest of its kind carried out in the local setting. The study's findings will be beneficial for policymakers to develop guidelines to reduce maternal cardiovascular disease morbidities and mortalities in Sri Lanka.
Highlights
Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries
First one is to determine the prevalence of CVD in early pregnancy and the second one is to determine the incidence of CVD during pregnancy
This study on cardiovascular disease in pregnancy is the largest study conducted of its kind in Sri Lanka
Summary
In Sri Lanka, cardiovascular disease complicating pregnancy is a major cause of maternal mortality, second only to postpartum hemorrhage[12,13]. National Maternal Mortality Reviews 2016 outcome dissemination[12] shows 120 maternal deaths in 2016, and of those, 24 (20%) were related to cardiovascular disease These included, complicated congenital heart condition (n=5), rheumatic valvular heart disease (n=3), myocarditis (n=2), cardiomyopathy (n=1), HELLP syndrome (n=3), eclampsia (n=4), and other hypertensive disorders (n=2). This lack of proper screening may lead to a substantial underestimation of the CVD burden It is the second leading cause of maternal deaths, locally available data on cardiovascular conditions complicating pregnancy are limited[13,15], probably due to late diagnosis and underestimation
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