Abstract
Heart disease in pregnancy is the cause of significant maternal and perinatal morbidity. We wanted to evaluate the maternal and perinatal outcomes of pregnant women with heart disease in Yaoundé, Cameroon. This was a cross sectional study with retrospective data collection of 45 pregnancies in 42 women with heart disease followed at three Yaoundé referral hospitals in Yaoundé, Cameroon from January 1st 2015 to December 31st 2020. We collected data on maternal obstetrical and perinatal outcomes. The frequency of pregnancies with heart diseases was 0.1%. The mean maternal age was 29.05 ± 6.5 years. At first antenatal visit, all patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class. Valvular heart disease (51.1%) was the most common type followed by cardiomyopathy (37.7%). Over half of the deliveries were vaginal (51.1%). A cesarean section was generally indicated for the usual obstetrical reasons (54.5%) and for heart disease (31.8%). Complications included 17 (37.7%) cases of heart failure, 6 (13.3%) cases of pulmonary edema, 2 (04.4%) cases of pulmonary embolism, 3 (06.6%) maternal deaths and 3 (06.3%) perinatal deaths, 14 (29.7%) premature births and 3 cases of (6.3%) intrauterine growth retardation. The maternal deaths were cases complicated by pulmonary edema and all had dilated cardiomyopathy. The maternal and perinatal outcomes of pregnant women with heart disease are marked in our environment by increased morbidity and mortality. Therefore, it is necessary to improve the prenatal, per partum and postpartum management of this high-risk group.
Highlights
Heart disease involves a broad spectrum of pathologies which might be congenital or acquired, functional or structural, cyanotic or acyanotic, or may include endocardial, myocardial or pericardial defects [1].Cardiac diseases in pregnancy are rare
All patients were in class I (84.4%) and II (15.6%) of the New-York Heart Association (NYHA) functional class
This result is close to those found by Khemiri et al in Tunisia (0.285%) and Lima et al in the U.S (0.2%). Other authors such as Diao et al in Senegal report a 2.7% rate of heart disease rate in pregnancy [5] [6] [9] [10] [11]. This high rate could be explained by the difference in the study populations; Diao et al carried out their study in a specialized cardiology unit and reported the frequency with respect to this population group, compared to ours which was carried in an obstetrics unit and the frequency calculated with respect to the number of deliveries
Summary
Heart disease involves a broad spectrum of pathologies which might be congenital or acquired, functional or structural, cyanotic or acyanotic, or may include endocardial, myocardial or pericardial defects [1].Cardiac diseases in pregnancy are rare. In the 1930s, it was estimated that 1% to 2% of all pregnancies were complicated by maternal cardiac disease and that 6% of these women died during pregnancy [2]. Current estimates of heart disease in pregnancy report a prevalence of 4% in the United States of America and worldwide estimates of 0.1% to 1.4% [3] [4]. Congenital heart disease is reported to be the most common cause of cardiac disease in pregnant women in developed countries [5]. Prevalence of rheumatic heart disease has been estimated at two to three cases per 1000 among school-age children in Africa who underwent clinical screening, and was recently reported to be about 10 fold higher if they had an ultrasound examination [6] [7]
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