Prognosis of Pregnancy and Childbirth in Heart Operated Patients: Experience in a 3 Referral Hospital in Mali, Case of the Gabriel University Hospital in Bamako

Introduction: In sub-Saharan Africa and Mali, young women who have had heart surgery want to become pregnant. The occurrence of pregnancy in these women who have had heart surgery is becoming more and more frequent in our country because of the persistence of acute rheumatoid arthritis (RAA) and especially the increasingly easy access to heart surgery. General Objective: To study the evolution of pregnancy and the prognosis of childbirth in women who have undergone heart surgery. Methodology: This was a retrospective and descriptive study that took place over a period of five (5) years in the gynecology-obstetrics department of University Teaching Hospital (UTH) Gabriel Touré and the cardiology department of UTH Luxembourg. Was included in the study any pregnant woman admitted to the gynecology-obstetrics department of UTH Gabriel Touré and having a history of heart surgery. The variables studied were the socio-demographic characteristics, the type of heart disease, the management, the evolution of the pregnancy and the prognosis. Data was typed on word processor, Excel and analyzed on Epi info and SPSS. The Chi square or Fisher exact test (for the number to 5) and the relative risk (RR) with confidence interval (CI) to 95% were calculated. P was considered as significant if . Results: Of the 13,388 pregnant women admitted to the gynecology/obstetrics department of UTH Gabriel Touré, 20 pregnant women had a history of heart surgery (1.49‰). The average age was 26 years old. The main cardiac pathology was valvular heart disease supported in 80.00% by the placement of a prosthesis. During pregnancy follow-up, 55% of pregnant women were on Anti-Vitamin K (AVK). In 95.00% of cases, heart disease was asymptomatic. We reported a case (5.00%) of iterative cardiac decompensation, in which cardiac ultrasound found a very arrhythmic heart, grade III mitral leak, and massive aortic leak. We did not find any case of prosthetic thrombosis. The abortion rate was 5.00%. The caesarean section rate was 31.60% and the instrumental extraction rate (forceps) was 23.10%. Newborns had a normal birth weight (68.40%), and were hypotrophic (15.80%) and premature (15.80%). In pregnant women on AVK, we reported 2 cases of fetal deaths in utero (10.00%). Conclusion: Surgical treatment of operable heart disease is a real prophylaxis for gravidocardiac accidents. Pregnancy can be well tolerated in patients who underwent heart surgery with artificial heart valves.