{
    "abstract": "Rheumatic heart disease (RHD) remains a leading cause of mortality and morbidity in pregnant patients in low- to middle-income countries. Apart from the clinical challenges, these areas face poor infrastructure and resources to allow for early detection, with many women presenting to medical services for the first time when they deteriorate clinically during the pregnancy. The opportunity for preconception counselling and planning may thus be lost. It is ideal for all women to be seen before conception and risk-stratified according to their clinical state and pathology. The role of the cardio-obstetrics team has emerged over the past decade with the aim of a seamless transition to and from the appropriate levels of care during pregnancy. Severe symptomatic mitral and aortic valve stenoses portend the greatest risk to both mother and fetus. In mitral stenosis, beta-blockers are the cornerstone of therapy and only a small number of patients require balloon valvuloplasty. Regurgitant lesions mostly require diuretics alone for the treatment of heart failure. The mode of delivery is usually vaginal; caesarean section is performed in those with obstetrical indications or in cases with severe stenosis and a poor clinical state. The postpartum period presents a second high-risk period for maternal adverse events, with heart failure and arrhythmias being the most frequent. This review aims to provide a practical evidence-based multi-disciplinary approach to the management of women with RHD in pregnancy.",
    "authors": [
        {
            "affiliation": "Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: BJ.Cupido@uct.ac.za.",
            "firstname": "Blanche",
            "initials": "B",
            "lastname": "Cupido"
        },
        {
            "affiliation": "Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; The Deanery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.",
            "firstname": "Liesl",
            "initials": "L",
            "lastname": "Z\u00fchlke"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology: Maternal Fetal Medicine Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.",
            "firstname": "Ayesha",
            "initials": "A",
            "lastname": "Osman"
        },
        {
            "affiliation": "Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.",
            "firstname": "Dominique",
            "initials": "D",
            "lastname": "van Dyk"
        },
        {
            "affiliation": "Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.",
            "firstname": "Karen",
            "initials": "K",
            "lastname": "Sliwa"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.cjca.2021.09.015",
    "journal": "The Canadian journal of cardiology",
    "keywords": [],
    "methods": null,
    "publication_date": "2021-09-28",
    "pubmed_id": "34571164",
    "results": null,
    "title": "Managing Rheumatic Heart Disease in Pregnancy: A Practical Evidence-Based Multidisciplinary Approach.",
    "xml": "<Element 'PubmedArticle' at 0x78850655bb00>"
}