title: Cardiac disease in pregnancy: a 4-year audit at Pretoria Academic Hospital.
abstract: BACKGROUND
  Pre-existing medical disease constitutes one of the five major causes of maternal death in South Africa. Increasing numbers of women with heart disease reach adulthood as a result of advances in diagnoses and treatment of heart disease in childhood.
  
  
  OBJECTIVE
  To assess the profile of cardiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH).
  
  
  METHODS
  A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 and December 2005.
  
  
  RESULTS
  Nearly 1% of all mothers who delivered at PAH had underlying cardiac disease. Most cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate 3.3%. The mean gestational age at delivery was 35 weeks; 18 (9.7%) babies were born before 34 weeks.
  
  
  CONCLUSIONS
  Cardiac disease in pregnancy is associated with high morbidity and mortality rates for mothers and their babies. Multidisciplinary evaluation with discussion of risk factors, appropriate family planning and optimising of the cardiac state before conception is advised.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Pretoria and Pretoria Academic Hospital. priya.somapillay@up.ac.za
authors.forename: P
authors.initials: P
authors.lastname: Soma-Pillay
authors.forename: A P
authors.initials: AP
authors.lastname: MacDonald
authors.forename: T M
authors.initials: TM
authors.lastname: Mathivha
authors.forename: J L
authors.initials: JL
authors.lastname: Bakker
authors.forename: M O
authors.initials: MO
authors.lastname: Mackintosh
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome; D011654:Pulmonary Edema / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology