Prevalence, types, maternal and perinatal outcomes of cardiac disease in pregnancy at a tertiary Hospital in the Eastern Cape, South Africa
Abstract
Background Cardiac disease is a leading non-obstetric cause of maternal morbidity and mortality, particularly in low- and middle-income countries. Methods Retrospective cross-sectional review of all deliveries from 01 January 2020 to 31 December 2022. Echocardiography-confirmed cardiac disease cases were identified. Data included demographics, lesion type and/or severity (New York Heart Association [NYHA]), timing of diagnosis, delivery characteristics and outcomes. Associations were examined using χ2 and t-tests (p < 0.05). Results Among 11 728 deliveries, 182 had cardiac disease (prevalence 1.6%, 95% CI: 1.34–1.80). Median age was 26 years (IQR 22–31); 50.6% presented with NYHA III–IV. Rheumatic heart disease (RHD) predominated (61.5%), mainly mitral stenosis (43.8%) and mitral regurgitation (38.3%). Cardiomyopathy accounted for 31.3%; peripartum cardiomyopathy (PPCM) comprised 78.9% of cardiomyopathies, most diagnosed postpartum (64.9%) and frequently with Left Ventricular Ejection Fraction (LVEF) < 45%. Preterm birth occurred in 46.9% of pregnancies, particularly with RHD–MS (mean gestational age (GA) 33.0 ± 6.0 weeks; p = 0.005). Caesarean delivery occurred in 72.0% (131/182), mainly for obstetric (41.8%) rather than cardiac indications. Maternal complications were common (67.6%), including pulmonary oedema (28.6%, 95% CI: 22.1–35.7), pulmonary hypertension (13.2%, 95% CI: 8.6–19.0) and ICU admission (12.1%, 95% CI: 7.8–17.6). Maternal case fatality was 4.9% (9/182; 95% CI: 2.3–9.2). Most neonates had favourable short–term outcomes (5–min Apgar ≥ 7 in 83.5%) and were discharged (87.7%). Conclusion Rheumatic heart disease and PPCM were the dominant lesions and major drivers of severe morbidity and mortality. Contribution The high burden of late presentation and severe functional limitation underscores the need for earlier detection, systematised cardio-obstetric care and strengthened primary prevention of RHD.