Echocardiography in Pregnant Indigenous Australians: Need for Screening?

Abstract

The Indigenous population of Australia has one of the highest rates of rheumatic heart disease (RHD) globally. RHD is more common in females and peak incidence corresponds with child-bearing age. Significant valvular disease can complicate pregnancy. In the Northern Territory, pregnant women are referred for echocardiogram if there are signs or symptoms of cardiac pathology or a history of RHD. To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of RHD. A retrospective review of all echocardiograms performed between 2014–2018 for an indication relating to pregnancy was completed. Data included indication, clinical history, echocardiographic findings and location of delivery. A total of 322 cases with echocardiography during pregnancy were reviewed, 195 Indigenous and 127 non-indigenous women (mean age 25 vs 30 years, p-value <0.01). Indigenous women had significantly higher rates of abnormal echocardiograms (35.9% vs 10%, p-value <0.01) and higher burden of rheumatic fever/RHD (39.4% vs 0.8% p-value <0.01). Moderate or severe valve lesions were detected in 26 (13.3%) indigenous women and 11 (5.6%) had previous cardiac surgery. Transfer to a tertiary centre with valve intervention services available was required for 12 (6.2%) Indigenous women. In the Northern Territory, Indigenous pregnant women have significantly higher rates of abnormal echocardiograms compared with non-indigenous counterparts. This is mainly due to RHD. Data suggests that Indigenous pregnant women are being under serviced by the current referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.