Types of cardiac diseases in women presenting with features suggestive of cardiac disease in peripartum period and their pregnancy outcomes in Muhimbili National Hospital, Dar es salaam.

Abstract

Background: Cardiac diseases continue to be a risk factor for maternal and neonatal morbidity and mortality. Objective: The aim of this study was to identify the types of cardiac conditions among women presenting with features suggestive of cardiac disease in the peripartum period and the maternal and perinatal outcomes at a tertiary care centre, Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods: A cross section study was done from April 2006 to January 2007. During the ten months period, a total of 97 women with features suggestive of cardiac disease in their third trimester of pregnancy and in puerperal period were evaluated and Echocardiography was done to identify the types of cardiac conditions, maternal and foetal outcomes were recorded and analyzed. Results: The majority (46.4%) had echocardiographic changes consistent with chronic hypertension (30.9% of them had LVH due to Hypertension and 15.5% had Hypertensive dilated cardiomyopathy). The second most frequent echocardiographic diagnosis was peripartum cardiomyopathy in 27.8% subjects, followed by Rheumatic heart disease in 16.5%subjects, Other diagnoses included, mitral valve prolapse in 3.1% patients, Atrial septal defects in 2.0% patients and pericarditis in 1(1.0%) patients. Majority (54.6%) of the patients were in NYHAIIIIIV. There was no case of maternal mortality. Three women developed life"threatening complications, cerebrovascular accidents. Intrauterine foetal complications were found in 17.5% of patients in total, IUGR accounting for 8.2% and IUFD, 9.3% There were 9.3% still births and perinatally, there were 10.3% reported deaths. Babies born from mothers with NYHA III/IV had statistically significant low Apgar score than babies born from mothers with NYHA I/II. There were more perinatal deaths from women who were in NYHA III/IV than in those who were in NYHA class I/II. This was statistically significant. Birth weight of babies born to mothers with functional classes III and IV were lower than those of functional classes I-II, though not statistically significant Conclusions: Hypertensive cardiac complications and Peripartum cardiomyopathy were the most frequent Echocardiographic diagnoses followed by Rheumatic heart disease in MNH, Dar es Salaam. Maternal morbidity and perinatal mortality increased with worsening maternal cardiac functional class.