title: Pregnancy in women with heart disease in sub-Saharan Africa.
abstract: BACKGROUND
  Although previous studies showed that pregnancy with heart disease is associated with significant complications, few focused on patients with valvular heart disease in sub-Saharan Africa.
  
  
  METHODS
  We report maternal and foetal outcomes in 50 pregnant women with heart disease admitted to the Department of Cardiology of the University of Dakar, during an 8-year period.
  
  
  RESULTS
  Rheumatic heart disease was observed in 46 women, seven of whom had previously been operated on. Among the remaining 39, 32 had mitral stenosis (isolated or associated with other valvular lesions). At admission, 36 women presented with pulmonary oedema, two with pulmonary embolism and 18 with arrhythmia. There were 17 maternal deaths (34%). Maternal death was associated with: mitral stenosis (P=0.03); severe tricuspid regurgitation (P=0.001); New York Heart Association functional class III or IV (P=0.001); symptoms of heart failure (P<0.001). A favourable maternal outcome was associated with: prior cardiac events (P<0.001); prior surgical valve replacement (P=0.03); cardiac prosthetic valve (P=0.03). There were 30 live births, six foetal deaths and five therapeutic abortions; nine women were lost to follow-up. Delivery was vaginal in 19 out of 30 cases and by caesarean section in 11 cases. Median gestational age at delivery was 28weeks (range, 8-38weeks). Five births occurred preterm. There were four stillbirths (neonatal mortality, 7.6%).
  
  
  CONCLUSIONS
  Heart disease severely impacts maternal and foetal outcome in our study. Pregnant women who underwent appropriate valve replacement before pregnancy had a better prognosis.
authors.affiliation: Service de cardiologie, CHU Aristide Le Dantec, faculté de médecine de Dakar, BP 6633, Dakar Étoile, Senegal. diaomaboury@hotmail.com
authors.forename: Maboury
authors.initials: M
authors.lastname: Diao
authors.forename: Adama
authors.initials: A
authors.lastname: Kane
authors.forename: Mouhamadou Bamba
authors.initials: MB
authors.lastname: Ndiaye
authors.forename: Alassane
authors.initials: A
authors.lastname: Mbaye
authors.forename: Malick
authors.initials: M
authors.lastname: Bodian
authors.forename: Mouhamadoul Mounir
authors.initials: MM
authors.lastname: Dia
authors.forename: Moustapha
authors.initials: M
authors.lastname: Sarr
authors.forename: Abdoul
authors.initials: A
authors.lastname: Kane
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Monsuez
authors.forename: Serigne Abdou
authors.initials: SA
authors.lastname: Ba
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D005865:Gestational Age; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D011256:Pregnancy Outcome; D011654:Pulmonary Edema / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000401:mortality*; D050497:Stillbirth / Q000453:epidemiology; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000401:mortality*