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Rheumatic heart disease in pregnancy: a report of 2 cases.

Abstract Pregnant women with severe mitral stenosis tend to experience clinical decompensation with approximately 50% mortality and they may experience adverse effects of the medication they are taking, notably congenital malformations from warfarin exposure. Corrective heart surgery may increase the risk of pregnancy loss. We present 2 cases of RHD in pregnancy. The first case was a 27-year-old patient in her first pregnancy with severe mitral stenosis. Caesarean section was done for foetal distress and she delivered a small for gestational age baby. She was closely monitored postpartum and was stable on discharge. She presented with supraventricular tachycardia and died in the coronary care unit 4 weeks postpartum. The second case was a 28-year-old who was on warfarin for a mechanical mitral valve. A foetal anomaly scan done at 20 weeks showed severe congenital malformations which were not compatible with extra-uterine life. The pregnancy was terminated and she recovered well. The first case illustrates the significant mortality risk with uncorrected severe rheumatic heart disease. The second case highlights the risks of warfarin on the foetus and the need to avoid mechanical heart valves if possible in young women. RHD patients require preconception counselling so they can make informed reproductive choices.
PMID
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Authors

Mayor MeshTerms
Keywords

Mitral stenosis

mechanical heart valve

pregnancy

Journal Title the pan african medical journal
Publication Year Start




PMID- 29721129
OWN - NLM
STAT- MEDLINE
DCOM- 20180510
LR  - 20180510
IS  - 1937-8688 (Electronic)
VI  - 28
DP  - 2017
TI  - Rheumatic heart disease in pregnancy: a report of 2 cases.
PG  - 298
LID - 10.11604/pamj.2017.28.298.14159 [doi]
AB  - Pregnant women with severe mitral stenosis tend to experience clinical
      decompensation with approximately 50% mortality and they may experience adverse
      effects of the medication they are taking, notably congenital malformations from 
      warfarin exposure. Corrective heart surgery may increase the risk of pregnancy
      loss. We present 2 cases of RHD in pregnancy. The first case was a 27-year-old
      patient in her first pregnancy with severe mitral stenosis. Caesarean section was
      done for foetal distress and she delivered a small for gestational age baby. She 
      was closely monitored postpartum and was stable on discharge. She presented with 
      supraventricular tachycardia and died in the coronary care unit 4 weeks
      postpartum. The second case was a 28-year-old who was on warfarin for a
      mechanical mitral valve. A foetal anomaly scan done at 20 weeks showed severe
      congenital malformations which were not compatible with extra-uterine life. The
      pregnancy was terminated and she recovered well. The first case illustrates the
      significant mortality risk with uncorrected severe rheumatic heart disease. The
      second case highlights the risks of warfarin on the foetus and the need to avoid 
      mechanical heart valves if possible in young women. RHD patients require
      preconception counselling so they can make informed reproductive choices.
FAU - Ziruma, Asaph
AU  - Ziruma A
AD  - Department of Obstetrics and Gynaecology, University of Zimbabwe, College of
      Health Sciences, Harare, Zimbabwe.
FAU - Nyakanda, Munyaradzi Innocent
AU  - Nyakanda MI
AD  - Department of Obstetrics and Gynaecology, University of Zimbabwe, College of
      Health Sciences, Harare, Zimbabwe.
FAU - Muyotcha, Annie Fungai
AU  - Muyotcha AF
AD  - Department of Obstetrics and Gynaecology, Parirenyatwa Central Hospital, Harare, 
      Zimbabwe.
FAU - Hove, Fungisai Nyarai
AU  - Hove FN
AD  - Department of Obstetrics and Gynaecology, Parirenyatwa Central Hospital, Harare, 
      Zimbabwe.
FAU - Madziyire, Mugove Gerald
AU  - Madziyire MG
AD  - Department of Obstetrics and Gynaecology, University of Zimbabwe, College of
      Health Sciences, Harare, Zimbabwe.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20171208
PL  - Uganda
TA  - Pan Afr Med J
JT  - The Pan African medical journal
JID - 101517926
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - Cesarean Section
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Humans
MH  - Mitral Valve Stenosis/*complications
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/*physiopathology
MH  - Pregnancy Outcome
MH  - Rheumatic Heart Disease/*complications
MH  - Warfarin/administration & dosage/*adverse effects
PMC - PMC5927558
OTO - NOTNLM
OT  - Mitral stenosis
OT  - mechanical heart valve
OT  - pregnancy
EDAT- 2018/05/04 06:00
MHDA- 2018/05/11 06:00
CRDT- 2018/05/04 06:00
PHST- 2017/10/18 00:00 [received]
PHST- 2017/10/20 00:00 [accepted]
PHST- 2018/05/04 06:00 [entrez]
PHST- 2018/05/04 06:00 [pubmed]
PHST- 2018/05/11 06:00 [medline]
AID - 10.11604/pamj.2017.28.298.14159 [doi]
AID - PAMJ-28-298 [pii]
PST - epublish
SO  - Pan Afr Med J. 2017 Dec 8;28:298. doi: 10.11604/pamj.2017.28.298.14159.
      eCollection 2017.