Maternal and neonatal outcomes in women diagnosed with rheumatic heart disease during pregnancy in Fiji. — The Association Specialists
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  3. Maternal and neonatal outcomes in women diagnosed with rheumatic heart disease during pregnancy in Fiji.

Maternal and neonatal outcomes in women diagnosed with rheumatic heart disease during pregnancy in Fiji. (24211)

Jimaima Kailawadoko-Matanaicake 1 , Mairini Rokovunisei 1 , Sukafa Matanaicake 1 , Kelera Sakumeni 1 , Reapi Lee 1 , Jack Kora'ai 1 , Sam Savea 1 , Camaro Waqanisau 1 , Salote Salaba 1 , Poonam Pal 1 , Latileta Nayacalevu 1 , Ilikena Malo 1 , Maria Mow 1 , Laisiana Matatolu 1 , Jyoti Mani 1 , Roneel Chandra 1 , Jokaveti Momo 1 , Sera Witherow 1 , Vijeta Mani 1 , Miriam Wheeler 2 , Nigel Wilson 2 , Joseph Kado 3
  1. Cure Kids, Suva, Fij
  2. Te Whatu Ora, Auckland, New Zealand
  3. The Kids Research Institute Australia, Perth, Australia

Background

Rheumatic Heart Disease (RHD) remains a major preventable cause of cardiovascular morbidity and mortality in low-and-middle-income countries. Population-level data on RHD in pregnancy are limited in Fiji and other Pacific settings.  Pregnancy may uncover previously undiagnosed valvular disease risking adverse maternal and neonatal outcomes.  This study describes the epidemiological profile, disease severity, and pregnancy outcomes of women newly diagnosed with RHD through antenatal screening in Fiji.

 

Methods

A prospective observational study was conducted as part of the Fiji AnteNatal Screening study.  Pregnant women attending four antenatal satellite clinics affiliated with the Colonial War Memorial Hospital (Suva), were recruited (1 August 2022 and 31 May 2023).  Women with newly diagnosed RHD on cardiologist-confirmed echocardiography were followed until six-weeks postpartum.  Data on demographics; and obstetric, cardiac, maternal and neonatal outcomes were extracted from antenatal registers and the Patient Information System. 

 

Results

Among the 2,402 women included in the final analysis, 564 were referred for confirmatory echocardiography and 499 completed assessments.  Newly diagnosed RHD was identified in 126 women.  Most cases were mild (n=84, 66.6%). Only 6% of women had severe disease (n=8/126).  Among women diagnosed with RHD, most were iTaukei, multiparous, accessed initial antenatal care in their second trimester, and were unemployed.  Mitral regurgitation was the predominant lesion, affecting 113 women (90%).  Neonatal outcomes among women with RHD included 125 live births and one stillbirth.  Low birth weight was recorded in seven infants, preterm birth in four, and neonatal intensive care admission in six.

 

Conclusion

Antenatal screening provides an important opportunity for early detection of previously undiagnosed RHD in Fiji.  In a resource-constrained health system, timely identification, echocardiographic assessment, and referral may enable multi-disciplinary care aimed at improving maternal and neonatal outcomes, reducing preventable complications, and lowering the risk of premature death among women living with RHD.