Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Department of Health, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2023 Feb;63(1):74-80. doi: 10.1111/ajo.13559. Epub 2022 Jun 28.
Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature.
The primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status.
A retrospective observational study was conducted over a 9.5-year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis.
One hundred and twenty-nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated.
We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group.
患有风湿性心脏病 (RHD) 的女性在应对妊娠和分娩时心脏储备能力可能较低，导致产科和心脏风险增加。北领地已多次被报道为澳大利亚 RHD 患病率最高的地区，但该地区关于妊娠的具体证据在文献中却很少。
本文的主要目的是描述北领地最大的产科转诊医院就诊的患有 RHD 的孕妇的基线特征和母婴结局。次要目的是评估与她们心脏状况相关的当前护理模式。
进行了一项为期 9.5 年的回顾性观察研究。收集了人口统计学、心脏、产科和麻醉数据进行分析。
共纳入 129 例妊娠进行分析。所有女性均被确定为土著或托雷斯海峡岛民，85%的女性属于 RHD 优先等级 2 或 3。在所有 28 例紧急剖宫产的患者中，仅有 1 例是因心脏原因而进行的。没有报告产妇或新生儿死亡。有 3 例早产是由于孕妇担心 RHD 心脏失代偿而进行的引产。没有新生儿死亡、室管膜下出血或呼吸窘迫综合征等重大不良新生儿结局。还评估了多学科护理。
我们观察到在一个患有轻度至重度 RHD 的女性队列中，母婴发病率低，且没有死亡。这些良好的结局是在一个多学科中心实现的，该中心在管理该人群的医疗和文化复杂性方面具有丰富的经验。
