Disease spectrum and short-term outcomes of obstetric patients with cardiac disease admitted to an obstetric critical care unit in South Africa
Keywords:
cardiac disease, CARPREG II risk score, echocardiography, lower middle-income countries, obstetric critical care unitAbstract
Background: Cardiac disease in pregnancy is a leading, indirect cause of maternal mortality. The disease spectrum differs between high-, middle-, and low-income countries. We describe the disease spectrum and short-term in-hospital outcomes in obstetric patients with cardiac disease at an obstetric critical care unit (OCCU) in an upper middle-income country (UMIC).
Methods: A single-centre, descriptive, historical cohort study was performed of all the obstetric patients with cardiac disease admitted between January 2018 and December 2019 to the Tygerberg Hospital (TBH) OCCU (n = 86) in Cape Town, South Africa (SA). We analysed groups according to the Cardiac Disease in Pregnancy (CARPREG) II and modified World Health Organization (mWHO) risk assessment tools.
Results: Three main groups were identified: valvular heart diseases (50%), cardiomyopathy (22%), and congenital heart disease (21%). The majority (88%) of 34 adverse cardiac outcomes occurred with cardiomyopathy and valvular disease. CARPREG II echocardiography high-risk parameters depended on the cardiac class: cardiomyopathy and valvular disease had a higher association (p < 0.001). Cardiac interventions were performed in 30 patients before pregnancy: 17 valvular, 12 congenital, and one Takayasu’s arteritis. Three interventions were performed during pregnancy and none postpartum. Peripartum OCCU interventions (ventilation and vasoactive support) were exclusively required by patients with cardiomyopathy (n = 12) and valvular disease (n = 11). Patients presenting with pulmonary oedema (p = 0.035) and needing ventilation (p = 0.027) or vasoactive support (p < 0.001) had longer OCCU stays.
Conclusion: Patients admitted to the OCCU with cardiac disease in obstetrics had mainly valvular heart disease, cardiomyopathy, and congenital heart disease. Adverse cardiac outcomes were associated with cardiomyopathy and valvular disease. Although SA is classified as an UMIC, our disease spectrum was more representative of a low- to middle-income country (LMIC). Patients with previous cardiac interventions had fewer adverse cardiac outcomes and booked earlier. The length of stay was longer when patients presented with pulmonary oedema and needed ventilation and vasoactive support.
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