Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis

Purpose Associations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy. Methods Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529). Findings The search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95). Interpretation RHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

Download Full-text

Maternal and fetal outcomes in rheumatic heart disease in pregnancy

International Journal of Research in Medical Sciences ◽

10.5455/2320-6012.ijrms20141172 ◽

2014 ◽

Vol 2 (4) ◽

pp. 1632

Author(s):

Dhivya Sethuraman ◽

Nirmala Ramachandran ◽

SAP Noorjahan ◽

Vijay Kanna

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Fetal Outcomes ◽

Heart Disease In Pregnancy ◽

Rheumatic Heart ◽

In Pregnancy

Download Full-text

Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000921 ◽

2020 ◽

Vol 142 (20) ◽

Author(s):

Raman Krishna Kumar ◽

Manuel J. Antunes ◽

Andrea Beaton ◽

Mariana Mirabel ◽

Vuyisile T. Nkomo ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Treatment Options ◽

Heart Association ◽

Population Based ◽

Diagnosis And Treatment ◽

Optimal Care ◽

Percutaneous Balloon ◽

Rheumatic Heart

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

Download Full-text

Maternal and fetal outcomes in rheumatic heart disease in pregnancy

International Journal of Clinical Obstetrics and Gynaecology ◽

10.33545/gynae.2020.v4.i1b.449 ◽

2020 ◽

Vol 4 (1) ◽

pp. 101-104

Author(s):

Dr. Suman Shivanagouda Patil ◽

Dr. Radhika Kondareddy ◽

Dr. SR Sheela

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Fetal Outcomes ◽

Heart Disease In Pregnancy ◽

Rheumatic Heart ◽

In Pregnancy

Download Full-text

Maternal and fetal outcomes in pregnant females with rheumatic heart disease

Indian Heart Journal ◽

10.1016/j.ihj.2021.01.012 ◽

2021 ◽

Author(s):

Roopali Khanna ◽

Deepti Chandra ◽

Sangeeta Yadav ◽

Ankit Sahu ◽

Neeta Singh ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Fetal Outcomes ◽

Pregnant Females ◽

Rheumatic Heart

Download Full-text

Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: a systematic review and meta-analysis of diagnostic accuracy

BMJ Open ◽

10.1136/bmjopen-2020-038449 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038449

Author(s):

Lisa Helen Telford ◽

Leila Hussein Abdullahi ◽

Eleanor Atieno Ochodo ◽

Liesl Joanna Zuhlke ◽

Mark Emmanuel Engel

Keyword(s):

Systematic Review ◽

Heart Disease ◽

Diagnostic Accuracy ◽

Receiver Operating Characteristic ◽

Rheumatic Heart Disease ◽

Operating Characteristic ◽

Meta Analysis ◽

Endemic Areas ◽

Rheumatic Heart ◽

Receiver Operating

ObjectiveTo summarise the accuracy of handheld echocardiography (HAND) which, if shown to be sufficiently similar to that of standard echocardiography (STAND), could usher in a new age of rheumatic heart disease (RHD) screening in endemic areas.DesignSystematic review and meta-analysis.Data sourcesPubMed, Scopus, EBSCOHost and ISI Web of Science were initially searched on 27 September 2017 and again on 3 March 2020 for studies published from 2012 onwards.Eligibility criteriaStudies assessing the accuracy of HAND compared with STAND when performed by an experienced cardiologist in conjunction with the 2012 World Heart Federation criteria among populations of children and adolescents living in endemic areas were included.Data extraction and synthesisTwo reviewers independently extracted data and assessed the methodological quality of included studies against review-specific Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. A meta-analysis using the hierarchical summary receiver operating characteristic model was conducted to produce summary results of sensitivity and specificity. Forest plots and scatter plots in receiver operating characteristic space in combination with subgroup analyses were used to investigate heterogeneity. Publication bias was not investigated.ResultsSix studies (N=4208) were included in the analysis. For any RHD detection, the pooled results from six studies were as follows: sensitivity: 81.56% (95% CI 76.52% to 86.61%) and specificity: 89.75% (84.48% to 95.01%). Meta-analytical results from five of the six included studies were as follows: sensitivity: 91.06% (80.46% to 100%) and specificity: 91.96% (85.57% to 98.36%) for the detection of definite RHD only and sensitivity: 62.01% (31.80% to 92.22%) and specificity: 82.33% (65.15% to 99.52%) for the detection of borderline RHD only.ConclusionsHAND displayed good accuracy for detecting definite RHD only and modest accuracy for detecting any RHD but demonstrated poor accuracy for the detection of borderline RHD alone. Findings from this review provide some evidence for the potential of HAND to increase access to echocardiographic screening for RHD in resource-limited and remote settings; however, further research into feasibility and cost-effectiveness of wide-scale screening is still needed.PROSPERO registration numberCRD42016051261.

Download Full-text

The American Heart Association’s Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000922 ◽

2020 ◽

Vol 142 (20) ◽

Cited By ~ 1

Author(s):

Andrea Beaton ◽

Flavia B. Kamalembo ◽

James Dale ◽

Joseph H. Kado ◽

Ganesan Karthikeyan ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

World Health ◽

Policy Statement ◽

World Health Assembly Resolution ◽

Worker Education ◽

Rheumatic Heart

Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.

Download Full-text