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CHILD HEALTH:
RHEUMATIC
HEART DISEASE
3% Embolism
CAUSES OF MATERNAL DEATH IN DEVELOPING COUNTRIES
Say et al. Global causes of maternal death: a WHO systematic analysis.
The Lancet Global Health. 2014.
National and local research confirms the tragic toll of RHD on pregnant women:
• In Senegal, 36% of pregnant women with RHD admitted to a tertiary cardiac
department died during pregnancy, at an average age of 29 years.
• In South Africa, 41% of indirect obstetric deaths are associated with heart disease,
overwhelmingly from RHD.
• In Brazil, 33% of women who died of heart disease during pregnancy had RHD. continued on next page >
RHD | EFFECTS ON NEWBORNS References
1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of
BACKGROUND OF MATERNAL CARDIAC DISEASE maternal death: a WHO systematic analysis. The Lancet Global Health. 2014; 2(6):
Women with symptomatic RHD do not have normally e323-e33.
2. Diao M, Kane A, Ndiaye M, Mbaye A, Bodian M, Dia M, et al. Pregnancy
functioning hearts. This increases the risk of serious in women with heart disease in sub-Saharan Africa. Archives of Cardiovascular
effects on developing babies including inter-uterine Disease. 2011; 2011: 370-4.
growth restriction, prematurity, and low birth weight. 3. Watkins D, Sebitloane M, Engel M, Mayosi B. The burden of antenatal heart disease
in South Africa: a systematic review. BMC Cardiovascular Disorders. 2012; 12(33).
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EFFECTS OF ANTICOAGULATION in patients with heart disease: experience with 1,000 cases. Clinical Cardiology.
Warfarin anticoagulation is associated with very poor 2003; 26: 135-42.
pregnancy outcomes including late pregnancy fetal loss in 5. Reimold S, Rutherford J. Valvular heart disease in pregnancy. The New England
Journal of Medicine. 2003; 349: 52-9.
an estimated 10% of cases. Warfarin also causes serious 6. Hameed A, Karalp I, Tummala P, Wani O, Canetti M, Akhter M, et al. The effect
developmental abnormalities in a large number of of valvular heart disease on maternal and fetal outcome of pregnancy. Journal of
surviving infants. American College of Cardiology. 2001; 37(3): 893-9.
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outcomes in women with mechanical prosthetic heart valves threated with
MATERNAL DEATH enoxaparin. British Journal of Obstetrics and Gynaecology. 2009; 116: 1585-92.
Infants who survive the death of their mother during, or 8. Cotrufo M, de Fero M, de Sandos L, Romano G, Della Corte A, Renzulli A, et al.
shortly after, labor begin life with a social and biologic Risk of warfarin during pregnancy with mechanical valve prostheses. Obstetrics and
Gynaecology. 2002; 99(1): 35-40.
disadvantage. Maternal deaths from RHD therefore 9. Vitale N, De Feo M, De Santo L, Pollice A, Tedesco N, Cotrufo M. Dose-dependent
contribute to the intergenerational transfer of poverty fetal complications of warfarin in pregnant women with mechanical heart valves.
which, in turn, predisposes to further RHD. Journal of American College of Cardiology. 1999; 33(6): 1637-41.
10. Yamin A, Boulanger V, Falb K, Shuma J, Leaning J. Cost of inaction on maternal
mortality: qualitative evidence of the impacts of maternal deaths on living children in
Tanzania. PLoS One. 2013; 8(8): doi:10.1371/journal.pone.0071674.