LAUSR

Rheumatic valvular disease (RHD) which has almost been eliminated in high-income countries is still common in low-income and middle-income countries. The presence of valvular heart disease in pregnant patients increases the risk to both the mother and the fetus.1 In this issue of the journal, Baghel et al present an observational study describing the outcome of a large group of pregnant women with RHD managed in one medical centre in India. Fifteen per cent of the patients had severe adverse cardiac outcome defined as death, heart failure, cerebrovascular accident and arrhythmias. Fetal outcome was also severely affected with a shortened gestational age at delivery and almost 40% newborns with low birth weight. These results confirm the potential risks associated with pregnancy in this patient population and emphasises the need for specific care to avoid or at least minimise maternal morbidity and mortality and assure fetal well-being. How can the outcome of pregnancy in women with RHD be improved? In this study, 26% of the patients were diagnosed during pregnancy and several of the cases resulting in maternal death presented late. These findings support the notion that management of women with RHD should ideally begin before conception or very early in pregnancy with a careful assessment and risk stratification as shown in table 1. The value of obtaining a careful history has been shown in this study and others,2 who found prior cardiovascular events to be a powerful predictor of pregnancy-associated complications. A 12-lead …