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1.
Cardiovasc J Afr ; 33(6): 322-328, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36162856

RESUMO

In South Africa, maternal mortality from cardiovascular disease remains high. The recent Saving Mothers report 2017-2019 from the Confidential Enquiries into Maternal Deaths revealed that indirect maternal death from medical and surgical disorders is the fourth commonest cause of maternal death, accounting for 16.9% of deaths, with cardiac disease accounting for one-third of this. The burden of rheumatic heart disease (RHD) is a significant contributor to maternal morbidity and mortality. The true burden is unknown due to limited data. The natural history of RHD confers additional risk as many cases may remain undiagnosed, with first presentation occurring during pregnancy. This undiagnosed subset of women may be the result of poor accessibility to healthcare facilities and primary healthcare interventions for acute rheumatic fever. RHD causes progressive damage to the heart valves, especially the left-sided valves, which eventually require surgical correction with mechanical prosthetic valves.


Assuntos
Próteses Valvulares Cardíacas , Morte Materna , Complicações Cardiovasculares na Gravidez , Cardiopatia Reumática , Feminino , Gravidez , Humanos , Anticoagulantes/efeitos adversos , Gestantes , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/terapia
2.
Cardiovasc J Afr ; 32(4): 228-232, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33950064

RESUMO

Rheumatic heart disease is one of the leading causes of valve dysfunction, resulting in prosthetic valve implantation. Changes in physiology and the haemodynamics of pregnancy increase the susceptibility of thrombosis to the prosthetic valve in the pregnant woman. Valve redo surgery carries a considerable risk of maternal and perinatal morbidity and mortality. Women of reproductive age should be well counselled regarding compliance with anticoagulation, contraception and pre-pregnancy planning.


Assuntos
Complicações Cardiovasculares na Gravidez/etiologia , Trombose/diagnóstico por imagem , Adulto , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/diagnóstico por imagem , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/terapia , Trombose/tratamento farmacológico , Trombose/etiologia , Trombose/cirurgia
3.
Niger J Clin Pract ; 19(1): 110-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26755228

RESUMO

BACKGROUND: Obstetrics and gynecology units in public hospitals in South Africa (SA) are often overloaded with patients. Most physical examinations/consultations in these units involve vaginal examination (VE) and often because of the rapid turnover of patients the pelvic examination may be performed hurriedly without due consideration being given to the psychosocial aspects of such procedures. OBJECTIVE: This study surveyed the attitudes of patients to VE and the use of chaperones. METHODS: A descriptive cross-sectional survey of patients attending obstetrics and gynecology clinics at a public hospital in SA was carried out. A structured questionnaire was used to collect sociodemographic data such as age, ethnic group, gravidity, feelings toward VE, and preferences about the gender of the examining doctor, as well as the presence of a chaperone. RESULTS: Most women (68%) were aged between 20 and 35 years. The respondents stated that the most intimate examination was VE in 48.3% and abdominal in 25% of cases; 19.0% and 1.5% of respondents felt that breast and rectal examinations, respectively, was the most intimate. On the response to the statement "there is no need for chaperone during VE;" 54% of the participants were in support of chaperone while 45.1% were against chaperone. Women aged 20-35 years, preferred a nurse as their chaperone; younger women, aged ≤19 years preferred their mother as a chaperone. CONCLUSION: In an SA public hospital, women are more likely to regard VE as the most intimate examination. Women are equivocal on the use of a chaperone and if it was necessary; nurses are their preferred choice except for teenagers, who preferred their mothers.


Assuntos
Atitude Frente a Saúde , Atitude , Exame Ginecológico/psicologia , Acompanhantes Formais em Exames Físicos , Relações Médico-Paciente , Encaminhamento e Consulta , Adolescente , Adulto , Idoso , Estudos Transversais , Emoções , Feminino , Ginecologia , Hospitais Públicos , Humanos , Pessoa de Meia-Idade , Mães , Obstetrícia , Médicos , África do Sul , Inquéritos e Questionários
4.
Cardiovasc J Afr ; 23(4): 216-21, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22614667

RESUMO

BACKGROUND: Cardiac disease in pregnancy is a common problem in under-resourced countries and a significant cause of maternal morbidity and mortality. A large proportion of patients with cardiac disease have prosthetic mechanical heart valve replacements, warranting prophylactic anticoagulation. AIM: To evaluate obstetric outcomes in women with prosthetic heart valves in an under-resourced country. METHODS: A retrospective chart review was performed of 61 pregnant patients with prosthetic valve prostheses referred to our tertiary hospital over a five-year period. RESULTS: Sixty-one (6%) of 1 021 pregnant women with A diagnosis of cardiac disease had prosthetic heart valves. Fifty-nine had mechanical valves and were on prophylactic anticoagulation therapy, three had stopped their medication prior to pregnancy and two had bioprosthetic valves. There were forty-one (67%) live births, two (3%) early neonatal deaths, 12 (20%) miscarriages and six (10%) stillbirths. Maternal complications included mitral valve thrombosis (n = 4), atrial fibrillation (n = 8), infective endocarditis (n = 6), caesarean section wound haematomas (n = 7), broad ligament haematoma (n = 1) and warfarin embryopathy (n = 4). Haemorrhagic complications occurred in five patients and all five required blood transfusions. CONCLUSION: Prophylactic anticoagulation with warfarin in patients with mechanical heart valve prostheses was associated with high rates of maternal and neonatal complications, including significant foetal wastage in the first and early second trimesters of pregnancy. Health professionals providing care for pregnant women with prosthetic heart valves must consistently advise on family planning matters, adherence to anticoagulation regimes and consider the use of prophylactic anticoagulant regimens other than warfarin, particularly during the first trimester of pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/epidemiologia , Anticoagulantes/efeitos adversos , Auditoria Clínica , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez , Centros de Atenção Terciária/estatística & dados numéricos , Anormalidades Induzidas por Medicamentos/etiologia , Adulto , Feminino , Seguimentos , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Osso Nasal/anormalidades , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Prognóstico , Estudos Retrospectivos , África do Sul/epidemiologia , Fatores de Tempo , Varfarina/efeitos adversos , Adulto Jovem
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