RETRACTED ARTICLE: Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study

Rezk, Mohamed; Elkilani, Osama; Shaheen, Abdelhamid; Gamal, Awni; Badr, Hassan

doi:10.1080/14767058.2017.1319932

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…RHD, cardiomyopathies and congenital heart disease were the most frequent cardiac diagnosis in this cohort, which is similar to findings from other LMICs [26–29]. A high proportion of women had pre‐existing cardiac disease that was only diagnosed in the current pregnancy, despite these women having been symptomatic in previous pregnancies.…”

Section: Discussionsupporting

confidence: 87%

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

Heemelaar

Agapitus

Akker

et al. 2022

Tropical Med Int Health

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Objectives First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population. Methods In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high‐income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018. Results Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower‐income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre‐existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9–38.0). Five women died. Cardiac events occurred in twenty‐two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long‐acting reversible contraception. Conclusions Despite several barriers, it was possible to implement a multidisciplinary service in a high‐burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context‐specific guidelines and better detection of cardiac disease.

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Section: Discussionsupporting

confidence: 87%

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

Heemelaar

Agapitus

Akker

et al. 2022

Tropical Med Int Health

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“…Poorer maternal and fetal outcomes were associated with higher risk scores (NYHA > II, NYHA > I with mitral stenosis, mWHO > 1, CARPREG/modified CARPREG > 0, or study‐specific factors such as mitral stenosis and anticoagulation therapy leading to increased maternal risks of heart failure, pulmonary hypertension, thromboembolic episodes, atrial fibrillation, and death). The CARPREG index underestimated cardiac events in low‐risk women but overestimated it in CARPREG > 0 in one study, possibly reflecting late diagnoses in pregnancy .…”

Section: Resultsmentioning

confidence: 99%

“…Late booking and/or infrequent antenatal care hampered early diagnosis and treatment and was associated with poorer cardiac and perinatal outcomes, yet the gestational age at first antenatal visit was reported in only 15 of 41 quantitative studies.…”

Section: Resultsmentioning

confidence: 99%

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Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

Vaughan

Dawson

Peek

et al. 2019

Birth

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Background Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence‐based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. Methods A search of 13 databases was supported by hand‐searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. Results The 43 included studies were predominantly conducted in tertiary care centers of low‐income and middle‐income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. Conclusions Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole‐of‐life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.

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“…The Sudanese report included in our review suggested that there were no cardiac deaths although the country has a high prevalence of RHD among young women [7,63,64]. Underdiagnosis of cardiac disease in LMIC may explain the wide range of maternal mortality from 0 to 34% that has been reported among pregnant women with cardiac disease [6,8,65‐69]. It is likely that only the most severe cases are identified in settings with limited access to facilities where cardiac disease can be diagnosed.…”

Section: Discussionmentioning

confidence: 99%

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

Heemelaar

Petrus

Knight

et al. 2020

Tropical Med Int Health

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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)

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RETRACTED ARTICLE: Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study

Abstract: Increased maternal age and body mass index together with NYHA class III-IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.

Cited by 7 publications

References 15 publications

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

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

Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis

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

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