Maternal-foetal and Neonatal outcomes in Pregnant Women with Cardiac Disease At Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Cardiac disease in pregnancy is an important cause of potentially life-threatening non-obstetric complications and is responsible for 10 to 15% of maternal deaths. The severity of the disease is more highly expressed in pregnant mothers living in resource-limited areas and is more likely to cause premature death in this population. Little is known about the burden of this problem in resource limited settings particularly in Sub Sahara Africa. Objective: To describe maternal, foetal and neonatal outcomes in pregnant women with cardiac disease seeking care at Moi Teaching and Referral Hospital. Methods: This was a longitudinal study that enrolled 91 pregnant and postpartum mothers with known cardiac disease or abnormal echocardiographic findings during pregnancy from October 2016 to October 2018. An interview-administered questionnaire was used to collect data. All participants were followed up to 6 weeks post-delivery. Maternal variables that could influence outcomes were captured and analysed. Categorical data are described using frequency and percentage, and continuous data are described using range, mean, standard deviation and median. The significance of the obtained results was determined at the 5% level. The chi-square test was used for categorical variables. Results: The median maternal age was 27 years (interquartile range, 23, 33), and the median body mass index was 22 kg/ m² (interquartile range 20,25). Rheumatic valvular disease was the predominant underlying cardiac condition, accounting for 88.9% of all cases and responsible for 72.7% of all maternal deaths in the series. Only 21.1% of patients had regular follow up at tertiary health care level during pregnancy. Sixty-three percent (63.3%) of the women had adverse maternal cardiac events. Obstetric events occurred in 60% of cases. Secondary pulmonary hypertension and caesarean section were associated with maternal cardiac events (80.0%, p=0.000 and 72.2%, p=0.037, respectively). Mitral regurgitation and aortic stenosis were associated with favourable maternal outcomes (p=0.011 and p=0.04, respectively). Foetal death occurred in 19.1%, while neonatal death occurred in 15.1%. The risk of adverse maternal cardiac events was associated with advanced New York Heart association functional class III and IV (p=0.000), World Health Organization extremely high-risk class (p=0.002) and mode of delivery (p=0.037). Maternal death was associated with a lack of health insurance (p=0.0044) and employment (p=0.01). Neonatal deaths were associated with home deliveries [60%, p<0.001]. Conclusion: Maternal, foetal and neonatal mortality and morbidity occurred in high rates, reflecting limited access to specialized care and preconception care. Recommendation: This study reaffirms the need to improve timely diagnosis and access to specialized care, thereby improve maternal, foetal and neonatal outcomes.