Department of Obstetrics & Gynaecology, Windhoek Central Hospital, Windhoek, Namibia.
Department of Obstetrics and Gynaecology, Leiden, The Netherlands.
Trop Med Int Health. 2022 Sep;27(9):803-814. doi: 10.1111/tmi.13804. Epub 2022 Aug 18.
First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population.
In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high-income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018.
Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower-income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre-existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9-38.0). Five women died. Cardiac events occurred in twenty-two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long-acting reversible contraception.
Despite several barriers, it was possible to implement a multidisciplinary service in a high-burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context-specific guidelines and better detection of cardiac disease.
首先，描述纳米比亚心内科妊娠女性多学科服务的实施过程、效益和挑战。其次，评估该人群的妊娠结局。
在纳米比亚的一家三级医院，由妇产科和心脏病科的工作人员实施多学科服务，包括孕前咨询、产前保健和可靠的避孕措施。由于没有当地适用的指南，因此使用了为高收入国家制定的管理指南。进行了一项队列研究，以评估心脏、产科和胎儿结局。该研究纳入了 2016 年 8 月 1 日至 2018 年 7 月 31 日期间转诊至该服务的患有心脏病的孕妇。
该服务的重要效益是综合方法、改善获得可靠避孕措施的机会以及深入了解不良结局的驱动因素。在使用现有指南时遇到了一些挑战，因为没有考虑到低收入环境下的具体情况因素，如感染率较高或获得医疗服务的障碍。该队列包括 65 名女性。16 名（24.6%）女性首次诊断出心脏病，其中 11 名女性患有先前存在的心脏病。与患有已知心脏病的女性相比，这些女性更常出现心力衰竭（75.0%比 6.1%，RR 12.5，95%CI 3.9-38.0）。5 名女性死亡。22 名女性发生心脏事件，其中 8 名发生血栓栓塞事件，2 名发生心内膜炎。根据现有指南，大多数女性没有预防指征。36 例妊娠中发生胎儿事件。妊娠后，超过一半的女性（35/65，53.8%）使用长效可逆避孕措施。
尽管存在多种障碍，但仍有可能在高负担环境中实施多学科服务。该队列的心脏和胎儿事件发生率较高。为了改善结局，重点应放在提供具体情况的指南和更好地发现心脏疾病上。
