Authors Keywords: cardiac disease, CARPREG II risk score, echocardiography, lower middle-income countries, obstetric critical care unit Abstract

Background: Cardiac disease in pregnancy is a leading, indirect cause of maternal mortality. The disease spectrum differs between high-, middle-, and low-income countries. We describe the disease spectrum and short-term in-hospital outcomes in obstetric patients with cardiac disease at an obstetric critical care unit (OCCU) in an upper middle-income country (UMIC).

Methods: A single-centre, descriptive, historical cohort study was performed of all the obstetric patients with cardiac disease admitted between January 2018 and December 2019 to the Tygerberg Hospital (TBH) OCCU (n = 86) in Cape Town, South Africa (SA). We analysed groups according to the Cardiac Disease in Pregnancy (CARPREG) II and modified World Health Organization (mWHO) risk assessment tools.

Results: Three main groups were identified: valvular heart diseases (50%), cardiomyopathy (22%), and congenital heart disease (21%). The majority (88%) of 34 adverse cardiac outcomes occurred with cardiomyopathy and valvular disease. CARPREG II echocardiography high-risk parameters depended on the cardiac class: cardiomyopathy and valvular disease had a higher association (p < 0.001). Cardiac interventions were performed in 30 patients before pregnancy: 17 valvular, 12 congenital, and one Takayasu’s arteritis. Three interventions were performed during pregnancy and none postpartum. Peripartum OCCU interventions (ventilation and vasoactive support) were exclusively required by patients with cardiomyopathy (n = 12) and valvular disease (n = 11). Patients presenting with pulmonary oedema (p = 0.035) and needing ventilation (p = 0.027) or vasoactive support (p < 0.001) had longer OCCU stays.

Conclusion: Patients admitted to the OCCU with cardiac disease in obstetrics had mainly valvular heart disease, cardiomyopathy, and congenital heart disease. Adverse cardiac outcomes were associated with cardiomyopathy and valvular disease. Although SA is classified as an UMIC, our disease spectrum was more representative of a low- to middle-income country (LMIC). Patients with previous cardiac interventions had fewer adverse cardiac outcomes and booked earlier. The length of stay was longer when patients presented with pulmonary oedema and needed ventilation and vasoactive support.

Author Biographies N Greeff, Stellenbosch University

Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg Hospital, South Africa

E Langenegger, Stellenbosch University

Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, South Africa

`PG Herbst, Stellenbosch University

Department of Cardiology, Stellenbosch University, Tygerberg Hospital, South Africa

C Lombard, Stellenbosch University

Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University and Biostatistics Research Unit, South African Medical Research Council and Department of Medicine, University of Cape Town, South Africa

A Theron, Stellenbosch University

Department of Anaesthesiology and Critical Care, Stellenbosch University, Tygerberg Hospital, South Africa

Issue Section

Original Research

License

By submitting manuscripts to SAJAA, authors of original articles are assigning copyright to the SA Society of Anaesthesiologists. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAJAA for educational and research purposes without obtaining permission.

The work is licensed under a Creative Commons Attribution-Non-Commercial Works 4.0 South Africa License. The SAJAA does not hold itself responsible for statements made by the authors.