Maternal deaths due to pre-existing cardiac disease : review article
2002
Heart disease in pregnancy is an uncommon problem in
the developed world, but reaches a high prevalence in
poor countries. In South Africa 0.65% of all pregnant
women have heart disease, and there is an unacceptably
high morbidity and mortality rate (9.5%). Rheumatic
heart disease accounts for most of this mortality, mitral
stenosis being the commonest lesion. In April 2000 the
National Committee on Confidential Enquiries into
Maternal Deaths (NCCEMD) reported that close to half
of non-obstetric maternal deaths in South Africa were
due to cardiac disease. Several preventable factors were
identified that precipitated decompensation and could
have accounted for this high mortality. Among them,
lack of adequate antenatal evaluation, uncontrolled fluid
infusion, failure to identify the patient at risk, and failure
to recognise the risk of autotransfusion in the postpartum
phase, were contributing factors. This report of the
problems seeks to address ways in which these difficulties
may be rectified.
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