The Screening And Evaluation Of Newly Diagnosed Cardiovascular Diseases In First Trimester Asymptomatic Pregnant Women In A Tertiary Antenatal Care Center In Turkey

Abstract

Screening and evaluation of newly diagnosed cardiovascular diseases in first-trimester asymptomatic pregnant women in a tertiary antenatal care center in Turkey Objective: Cardiovascular disease (CVD) is the leading cause of death during pregnancy. Therefore, its detection early in pregnancy is of great importance. In this study, we aimed to investigate the rate and spectrum of CVD among healthy women in the first trimester of pregnancy. Methods: A total of 900 women in the first trimester of pregnancy, who attended the antenatal outpatient clinic of a tertiary care center in Ankara, Turkey, for a routine pregnancy examination, were recruited into this prospective study. Patients with a history of chronic systemic diseases, CVD, and/or a family history of an early onset CVD, and multiple pregnancies were excluded. Patients who were included in the study underwent electrocardiography and transthoracic echocardiography by the same cardiologist. Results: The rate of newly diagnosed CVD cases among asymptomatic pregnant women without any cardiac or clinical risk factors was 5.2% (n=47). The following CVDs were detected: rheumatic heart disease (n=26; 55.3%), congenital heart disease (n=13; 27.6%), and isolated valve disease (moderate and severe) (n=8; 17%). The mitral valve prolapse was detected in 32 women (3.5%) and atrial septal aneurysm in 51 women (5.67%). Thirty women (3.3%) had arrhythmia. Conclusion: The CVD rate of 5.2% among healthy women in the first trimester of pregnancy shows that the clinicians must keep in mind that during pregnancy, physiological changes in the cardiovascular system may aggravate an undiagnosed disease, and they should be alert even in case of mild cardiac symptoms that may interfere with pregnancy complaints.

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

“…Women with pregnancy-acquired cardiac complications or congenital heart disease unmasked during pregnancy had a lower adherence score due to the change in their care trajectory during the antepartum period and experienced morbidities (See S1 Table ). The lack of routine prenatal health (including cardiac) screening, preterm delivery, and late diagnosis in pregnancy contributed to a lack of awareness and preparedness previously reported [20,42]. Clinicians were surprised and unprepared for potential cardiac complications in pregnancy if asymptomatic women in the first trimester later experienced sudden clinical deterioration.…”

“…A study from Turkey demonstrated a 5.2% prevalence of cardiovascular disease (CVD) among asymptomatic first trimester women in a tertiary obstetric centre. This emphasises the importance of opportunistic as well as routine health and CVD screening by general practitioners in all patients whatever their age, and for newly pregnant women at their first antepartum visit [42]. Prenatal screening includes obtaining the pregnant woman's medical history and family members' medical history, cardiac status, and associated risk factors [20].…”

Characteristics Shifting of Heart Disease in Pregnancy: A Report from Low Middle-Income Country

“…In western countries, the prevalence increases from about 0.2 -0.4% to 1 -4% during the last few years 1,2 . However, data on Asia are varied and limited, ranging from 0.3 -5.2%, including Indonesia [3][4][5][6] .…”

The screening of heart disease by cardiac auscultation and electrocardiography examination in pregnant women in Puskesmas Tegalrejo, Yogyakarta, Indonesia

“…Progressive pulmonary vascular obliteration can cause right heart failure and stroke from intracardiac shunting, which are examples of various preventable causes of poor maternal outcomes. 7 Data from the Indonesian Ministry of Health in 2015 showed that the maternal mortality rate is 305 out of 100,000 births, and the maternal mortality rate due to heart disease in pregnancy ranges from 1-2%. The risk of maternal death is increased in cases with pulmonary hypertension, Eisenmenger syndrome, coarctio aorta, and complicated Marfan syndrome.…”

“…Several studies on cardiovascular abnormality screening methods have been performed by combining cardiac auscultation, 12 lead electrocardiogram (ECG) and echocardiography. 7,10 The ECG examination is a simple, effective, and easy to perform method for diagnosing CVD. Based on our previous study, this program has been proven effective as a screening method of CVD in children.…”