Maternal mortality due to cardiac disease in low‐ and middle‐income countries

Abstract

objectives To assess the frequency of maternal death (MD) due to cardiac disease in low-and middle-income countries (LMIC).methods Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital-based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac-related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac-related MD/100 000 live births) and proportion of cardiac-related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country.results Forty-seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac-related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac-related MD was higher in countries with a lower MMR.conclusions The burden of cardiac-related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called 'obstetric transition': pre-existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.keywords cardiac disease, maternal mortality, low-and middle-income countries Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 17 (partnerships for the goals)

Experiences of a dedicated Heart and Maternal Health Service providing multidisciplinary care to pregnant women with cardiac disease in a tertiary centre in Namibia

“…women had a thromboembolic event (thrombus in the left ventricle [4], stroke [2], pulmonary embolism [1] and mechanical valve thrombosis [1]). One stroke and the valve thrombosis occurred in the first trimester and the remaining six thromboembolic events occurred postpartum.…”

Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR): design and methodology

“…Some Indian states are still in stage III of obstetric transition with a MMR as high as 215 per 100,000 live births, while few others have already moved into stage IV [ 7 ] with a MMR as low as 43/100,000 live births [ 14 ]. States with lower MMR have to shift focus to target reduction of deaths due to heart diseases and other indirect causes, which needs a different set of interventions with multidisciplinary approach [ 15 ].…”

Echocardiography for the Pregnant Heart

“…Cardiovascular disease (CVD) is a leading cause of maternal morbidity and mortality in the USA and globally [1][2][3][4][5][6][7]. Furthermore, maternal mortality is rising in the USA, with 41% of deaths retrospectively evaluated deemed to have been preventable [8].…”