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In north African countries, rheumatic heart disease remain dominant with weak support due to lack of information, financial, diagnostic delay, but also management difficulties of rheumatic fever. And the combination of a pregnancy with rheumatic heart disease remains high risk to the physiological changes. This is a cross-sectional study, retrospective, spread over 13 years, from 1st January 2000 to 31st December 2015 at the Obstetric Intensive Unit Care department, in collaboration with the Cardiology department at the University Hospital of Casablanca (Morocco). Including criteria were: any woman in labor admitted to ICU, with cardiac decompensation, whether or not known and followed for heart disease. During the study period 150 patients were collected whose average age was 30 years ± 2 years, 68.6% was multiparous, 24.6% was followed by a cardiologist was under medical treatment. Among them, 15.3% were operated for their heart disease. At admission, 43.3% of women in labor were dyspnoea stage (NYHA) III, the pulmonary edema was found in 44.6% of patients. The average ejection fraction was 43.3%. Rheumatic valvular heart disease has been dominated by mitral stenosis in 70% (1) and aortic stenosis in 15.3%. The surgical indication was raised in 30% of pregnant women. Cesarean was practiced in 62%. Sixteen cases had thromboembolic complications. Maternal mortality of our study was 9.3%, however fetal outcomes were hypotrophy in 46.6% and 53.3% were premature. And 26% were complicated by death. Prognostic factors of morbidity and mortality of women in labor was: living in a rural environment, The discovery of heart disease during pregnancy, lack of following the heart disease, lack of monitoring the pregnancy, LVEF ≤ 50%, primary pulmonary hypertension, Left obstructive heart disease. In conclusion, pregnancy in woman with heart disease requires effective strategy for implementing prevention strategy of rheumatic fever and followed severe follow-up for patients with heart disease. |
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