According to any standard textbook the main cause of cardiac disease in pregnancy is rheumatic valvular disease, but an analysis of the cases seen at Il Sin Women´s Hospital shows that the majority of patients presenting here with cardiac failure have no underlying heart disease.
A stimulus to further investigation came after personal communication from a physician in Nigeria who commented on the very similar pattern of peripartum cardiac failure in Nigeria to that reported in a series of 21 cases from the National Medical Center in 1965 in which there was no underlying heart disease. As this type of patient evidently does not -occur generally throughout the world it was decided to analyse the case histories of the patients with cardiac disease cadmitted to the Il Sin Women´s Hospital with particular Teference to any underlying cause.
A series of 194 patients admitted with cardiac disease in pregnancy from Jan. 1st 1969 to August 31st 1972 was analysed.
The results: of the analysis are summarized as the follow
1.Among patients, 125 patients were delivered or treated during pregnancy at 11 Sin Women´s Hospital & 69 patients were admitted after delivery. 2.In the majority of cases, 118(61 %), no organic disease could be found and only 68(35 %) 3. Most of the organic lesions ´were valvular-46 cases(Table 3).
4. During the 3 years 8 months :of the survey there were 14, 381,deliveries and 125 patients with heart disease were admitted an incidence of 0. 86 %(Table 1) 5.The time of presentation in cardiac failure was analysed. The majority of cases were in the postpartum period but 67 cases (57 %) presented between 38 weeks and the first week postpartum.
6. In 62 (53 %) of the-patients cardiac failure occured in the first viable pregnancy, 62 (53 patients were primipara this was much higher than the normal incidence of 44 % (Table 5).
7. The age of the patients was correspondingly young, 83 (70%) patients being under 30 years of age. Compared to the normal distribution however there was a much higher incidence in the 19-25 yrs age group´ 36% in the heart cases & only 28%o in normal cases.
8. Cardiac failure with no underlying heart disease appears to be only of a temporary nature and when the precipitatit factor has passed, there is no need to continue active treatment(Table 11).
9. The main identified causative factors appear to be anemia and toxemia, and as these are both preventable with good prenatal care, we stress the need for still further education. of the medical profession & the public in the need for regular antenatal examination.
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