{
    "abstract": "Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature.\nThe primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status.\nA retrospective observational study was conducted over a 9.5-year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis.\nOne hundred and twenty-nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated.\nWe observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.",
            "firstname": "Chor Kiu Maree",
            "initials": "CKM",
            "lastname": "Lam"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.",
            "firstname": "Jane",
            "initials": "J",
            "lastname": "Thorn"
        },
        {
            "affiliation": "Department of Health, Perth, Western Australia, Australia.",
            "firstname": "Xylyss",
            "initials": "X",
            "lastname": "Lyon"
        },
        {
            "affiliation": "Department of Anaesthesia, Royal Darwin Hospital, Darwin, Northern Territory, Australia.",
            "firstname": "Edith",
            "initials": "E",
            "lastname": "Waugh"
        },
        {
            "affiliation": "Department of Anaesthesia, Royal Darwin Hospital, Darwin, Northern Territory, Australia.",
            "firstname": "Ben",
            "initials": "B",
            "lastname": "Piper"
        },
        {
            "affiliation": "Department of Cardiology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.",
            "firstname": "Edwina",
            "initials": "E",
            "lastname": "Wing-Lun"
        }
    ],
    "conclusions": "We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group.",
    "copyrights": "\u00a9 2022 Royal Australian and New Zealand College of Obstetricians and Gynaecologists.",
    "doi": "10.1111/ajo.13559",
    "journal": "The Australian & New Zealand journal of obstetrics & gynaecology",
    "keywords": [
        "First Nations",
        "Northern Territory",
        "model of care",
        "pregnancy",
        "rheumatic heart disease."
    ],
    "methods": null,
    "publication_date": "2022-06-29",
    "pubmed_id": "35762262",
    "results": "One hundred and twenty-nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated.",
    "title": "Rheumatic heart disease in pregnancy: Maternal and neonatal outcomes in the Top End of Australia.",
    "xml": "<Element 'PubmedArticle' at 0x7885061289a0>"
}