Maternal deaths due to pre-existing cardiac disease

Heart disease in pregnancy is an uncommon problem in the developed world, but reaches a high prevalence in poor countries. In South Africa 0.65% of all pregnant women have heart disease, and there is an unacceptably high morbidity and mortality rate (9.5% ). Rheumatic heart disease accounts for most of this mortality, mitral stenosis being the commonest lesion. In April 2000 the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) reported that close to half of non-obstetric maternal deaths in South Africa were due to cardiac disease. Several preventable factors were identified that precipitated decompensation and could have accounted for this high mortality. Among them, lack of adequate antenatal evaluation, uncontrolled fluid infusion, failure to identify the patient at risk, and failure to recognise the risk of autotransfusion in the postpartum phase, were contributing factors. This report of the problems seeks to address ways in which these difficulties may be rectified.