Prevalence and pattern of cardiac disorders among pregnant women attending antenatal clinic at their first clinic visit at Muhimbili National Hospital.

Abstract

Background: Increased cardiac demands during the course of pregnancy potentially increase morbidity and mortality in women with underlying heart diseases. In our setting, most women in child bearing age become pregnant without appraising their health particularly cardiac status and no effort are made at Antenatal clinic to screen for cardiac diseases. Improved quality of health care at delivery facilities in some countries (including Tanzania) has lead to improved survival rates for those with congenital and valvular heart disease leading to an increasing number of heart disease patients who are reaching child bearing age, problems in most young women remain un detected especially in those with minor cardiac disorders. It is consequently essential to thoroughly evaluate expectant women for underlying cardiovascular disease in order to provide optimal care during pregnancy.

Objective: To determine the prevalence and pattern of cardiac disorders among pregnant women attending Antenatal clinic at Muhimbili National Hospital (MNH) – Dar es Salaam. Methods: A hospital based descriptive cross-sectional study done from June to December 2012. A total of 310 pregnant women attending their first antenatal clinic at Muhimbili National Hospital (MNH) were recruited using a systematic sampling technique. A standard structured questionnaire was used to collect demographic data and other cardiac related symptoms. Each participant also had a thorough cardiovascular examination; Electrocardiogram and Echocardiogram were performed to identify types of cardiac disorders. Results: The overall prevalence of cardiac disorders among pregnant women attending antenatal clinic was found to be 29.7%. The prevalence of cardiac disorder (detected by ECHO) was found to be 20.6% .Of these pregnant women 30 (9.7%) had LVH likely due to chronic hypertension, followed by Mitral valve prolapse in 25(8.1%) pregnant women. The most frequent presenting symptoms and signs were easy fatigability in 221 (71.3%) followed by edema of the lower limbs in 190(63.1%) and palpitations 169 (54.9%).Majority of clinical findings were not significantly associated with the presence of ECHO abnormality. Conclusion: The prevalence of cardiac disorders among pregnant women attending their first ANC at Muhimbili National Hospital was found to be high at 29.7%. Hypertension was found to be the most prevalent cardiac related disorder followed Mitral valve prolapse however the prevalence of congenital heart disease was found to be low and majority of pregnant women have not been screened before regarding their cardiac status Recommendations: Screening for cardiac disease as part of ANC should be done and preferably women should be screened for cardiac disorders before pregnancy.