Pregnancy outcomes in women with heart disease at the Colonial War Memorial Hospital, Suva, Fiji.

Background: Cardiac disease in pregnancy is the third most common cause of maternal mortality in Fiji. The aim of this study was to determine the characteristics of pregnant women with heart disease presenting to the Colonial War Memorial Hospital (CWMH). Method: A retrospective review of case notes of all pregnant women identified with heart disease who birthed in the hospital between January 2011 and December 2013 (36 months). Findings: Of the 24,844 livebirths in CWMH during the study period, 153 women, aged 15 to 43 years of age, were confirmed with a cardiac lesion, which gives a prevalence rate of 6.2 per 1,000 livebirths. Rheumatic heart disease was the commonest cardiac lesion (112, 90%) followed by congenital heart disease (6, 5%) and hypertensive cardiomyopathy (3, 2%). Most of the cardiac lesions (120, 73%) were detected during pregnancy. There was a higher rate of intervention, morbidity and mortality associated with a cardiac lesion. The rate of instrumental deliveries, caesarean sections and admissions to intensive care were 3.5, 1.5 and 44 times higher compared to pregnant women without a heart lesion. The case-fatality rate was 2.0%. Conclusion: Women with a cardiac lesion in pregnancy had more interventions, higher morbidity and mortality compared to women without a cardiac lesion. Early diagnosis and evaluation of cardiac function were essential for better maternal outcomes. All pregnant women should be screened with an echocardiogram to improve early detection of cardiac lesions.