Adverse Maternal, Perinatal Outcomes and Associated Factors in Pregnant Women With Rheumatic Heart Disease in Kenyatta National Hospital From January 2015 to December 2020

Abstract

Background: Rheumatic heart disease (RHD) is the most common type of cardiovascular diseases accounting for approximately 70%. The prevalence of RHD has been significantly higher in low income settings especially in Africa and South Asia. RHD has been associated with adverse maternal outcomes such as heart failure, thromboembolism, postpartum haemorrhage and mortality. Adverse perinatal outcomes associated with RHD include small for gestation age, prematurity, intensive care unit admission and neonatal mortality. However, the investigation on these adverse outcomes and associated factors has not been fully explored. Purpose of the study: To determine adverse maternal, perinatal outcomes and associated factors in pregnant women with rheumatic heart disease in Kenyatta National hospital from January 2015 to December 2020 Methods and Analysis: The study was analytical cross-sectional study design targeting pregnant women with rheumatic heart disease at Kenyatta National Hospital from January 2015 to December 2020. A consecutive sampling technique was used in extracting all files that meet the inclusion criteria within the study period. Data abstraction tool was used in obtaining data from patient files. The data that was abstracted include maternal characteristics, clinical characteristics, classification of RHD, maternal, perinatal outcomes. The study utilized both descriptive and inferential analysis. Categorical data was analyzed using frequencies and percentages. Continuous data was analyzed using mean and standard deviation for normally distributed variables while median and interquartile range was used for variables with skewed data. Pearson chi-square test for association was done to determine independent factors associated with each specific adverse outcome identified. A Multivariable logistic regression was conducted to control for confounders. Data analysis was done using SPSS software version 26. The significance level was 0.05. Results: The average age was 28 years with average range of 18 – 43 years. The findings showed that 37.8%(n =31) of the patients had at least one adverse outcome. Among those with adverse maternal outcomes, 56.1%(n =46) had heart failure, 43.9%(n =36) had delivery through caesarean section, 37.8%(n =31) had sustained arrythmia, 25.6%(n =21) were admitted to cardiac ICU while maternal mortality was 13.4%(n =11). The results showed that 36.6%(n =30) had adverse perinatal outcomes. The findings showed that 29.3%(n =24) had prematurity, neonatal mortality was 24.4%(n =20), 19.5%(n =16) were small for gestational age, Intrauterine fetal demise occurred among 15.9%(n =13) while 13.4%(n =11) were stillbirths. Perinatal mortality was 53.7%(n =44). Multivariate analysis revealed that those who were referred (AOR =2.21, 95%CI: 1.21 – 5.23, p =0.014). Those who were classified stage IV as per the New York Heart classification (AOR = 2.47, 95%CI:1.02 – 10.57, = 0.006) and those who were diagnosed with cardiac disease before pregnancy (AOR =0.42, 95%CI: 0.14 – 0.81, p<0.001) were significantly associated with adverse maternal outcome. Independent factors associated with perinatal adverse outcome included cardiac disease during pregnancy (AOR =4.51, 95%CI: 2.12 – 8.31, p<0.001) and history of cardiac disease AOR = 1.86, 95%CI: 1.02 – 4.28, p = 0.020. Conclusion and recommendation: The findings have showed that maternal and perinatal adverse outcomes among patients with RHD in pregnancy. Referral status, NYHA, time of diagnosis and history of cardiac disease have been found to influence adverse outcomes. Thus, implementation of a multidisciplinary approach may be pivotal for providing adequate counselling and management of these women, thus possibly improving their outcomes.