Cardiac disease accounts for one-third of indirect maternal deaths from medical and surgical disorders in South Africa, with rheumatic heart disease being a significant contributor.
How should anticoagulation be managed in pregnant women with mechanical prosthetic heart valves?
This review highlights the significant burden of rheumatic heart disease and the challenges of managing anticoagulation in pregnant women with mechanical prosthetic valves in South Africa.
In South Africa, maternal mortality from cardiovascular disease remains high. The recent Saving Mothers report 2017-2019 from the Confidential Enquiries into Maternal Deaths revealed that indirect maternal death from medical and surgical disorders is the fourth commonest cause of maternal death, accounting for 16.9% of deaths, with cardiac disease accounting for one-third of this. The burden of rheumatic heart disease (RHD) is a significant contributor to maternal morbidity and mortality. The true burden is unknown due to limited data. The natural history of RHD confers additional risk as many cases may remain undiagnosed, with first presentation occurring during pregnancy. This undiagnosed subset of women may be the result of poor accessibility to healthcare facilities and primary healthcare interventions for acute rheumatic fever. RHD causes progressive damage to the heart valves, especially the left-sided valves, which eventually require surgical correction with mechanical prosthetic valves.
Jenneker et al. (Thu,) conducted a review in Pregnant women with mechanical prosthetic heart valves and rheumatic heart disease. Anticoagulation was evaluated. Cardiac disease accounts for one-third of indirect maternal deaths from medical and surgical disorders in South Africa, with rheumatic heart disease being a significant contributor.