The Spectrum of RHD Management in Pregnancy on Assessing the Time of Diagnosis, Severity of Cardiac Lesions, and the Challenges
Abstract:
Rheumatic heart disease (RHD) poses a
significant challenge during pregnancy, especially in low- and middle-income
countries, where it affects millions of individuals, primarily young women of
childbearing age. This autoimmune condition, often triggered by group A
streptococcal infections, leads to chronic inflammation and scarring of heart
valves, resulting in insufficiency and stenosis. Pregnancies complicated by
cardiovascular diseases, including RHD, contribute to maternal mortality rates
and present unique management dilemmas due to the physiological changes
accompanying gestation. This case series presents three cases illustrating the
complexities of managing RHD during pregnancy. Case 1 describes a gravid woman
with a history of previous normal delivery and hepatitis B surface antigen
positivity, requiring emergency intervention due to fetal distress and elevated
blood pressure. Case 2 details the management of RHD in a woman with
hypothyroidism presenting with labor pain at term gestation. Case 3 presents
the challenges of managing RHD in a primigravida with a history of
nephroureterectomy for ectopic ureter insertion. Understanding the pathological
mechanisms and tailored management strategies for pregnant women with RHD is
crucial for improving care and outcomes.
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