Pregnancy in women with heart disease in sub-Saharan Africa

Background. - Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa. Methods. - We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period. Results. - Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P = 0.03); severe tricuspid regurgitation (P = 0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P < 0.001). A favourable maternal outcome was associated with: prior cardiac events (P < 0.001); prior surgical valve replacement (P = 0.03); cardiac prosthetic valve (P = 0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28 weeks (range, 8-38 weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%). Conclusions. - Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis. (C) 2011 Elsevier Masson SAS. All rights reserved.