Abstract:
Maternal mortality ratio in low- to middle-income countries
(LMIC) is 14 times higher than in high-income countries. This
is partially due to lack of antenatal care, unmet needs for family
planning and education, as well as low rates of birth managed
by skilled attendants. While direct causes of maternal death
such as complications of hypertension, obstetric haemorrhage
and sepsis remain the largest cause of maternal death in LMICs,
cardiovascular disease emerges as an important contributor to
maternal mortality in both developing countries and the developed
world, hampering the achievement of the millennium
development goal 5, which aimed at reducing by three-quarters
the maternal mortality ratio until the end of 2015.
Systematic search for cardiac disease is usually not
performed during pregnancy in LMICs despite hypertensive
disease, rheumatic heart disease and cardiomyopathies being
recognised as major health problems in these settings. New
concern has been rising due to both the HIV/AIDS epidemic
and the introduction of highly active antiretroviral therapy.
Undetected or untreated congenital heart defects, undiagnosed
pulmonary hypertension, uncontrolled heart failure
and complications of sickle cell disease may also be important
challenges. This article discusses issues related to the
role of cardiovascular disease in determining a substantial
portion of maternal morbidity and mortality. It also presents
an algorhitm to be used for suspected and previously known
cardiac disease in pregnancy in the context of LIMCs.
