Rheumatic Heart Disease In Pregnancy

Rheumatic Heart Disease in Pregnancy

Rheumatic Heart Disease In Pregnancy

Introduction
Pregnant women usually undergo numerous check-ups during pregnancy terms in
order to ensure that the mother to be, and the child she is carrying are in good or
perfect condition, that would promote normal healthy growth. Pre-natal care and
preconception care is very crucial to women health care, especially during their
childbearing years. This health care is important as it influences pregnancy outcomes
in a positive direction, with the main aim of identifying social and medical conditions,
which may affect the foetus or the mother and put them at risk.
The key elements entail obtaining genetic history, health history or previous
complications that may affect a pregnant woman. Clinicians provide these vital
services to ensure that both the mother and the foetus are safe. Moreover, the rate of
teen pregnancies is on the rise in many developed and developing countries, where
young pregnant teenagers and mothers do not have the basic and important health
education concerning pregnancy, and how risk factors such as previous ailments could
affect their pregnancies.
Importantly, heart diseases during pregnancy such as rheumatic heart disease among
pregnant women present numerous risks, and various other complications which can
lead to stroke, heart failure, and arrhythmia. Moreover, women who have histories of
congenital heart disease, require immediate and regular health care monitoring,
because they are at higher risk of giving birth to a child with a heart disease defect.
The aim of this study is to investigate the link between Rheumatic Heart Disease
(RHD) and pregnancy, and how this condition affects pregnancy, proper health
education and advice concerning health promotion activities for both the mother and
the foetus. Pregnant teens with cardiovascular problems face various social and

Rheumatic Heart Disease In Pregnancy

medical issues, and the study will look at roles the nurses or clinicians play, at
handling adolescent patients with heart diseases.

Rheumatic Heart Disease and Pregnancy

This case concerns Heather, a sixteen year old female living with her extended family
in a community close to Darwin, Australia. Heather has just become pregnant
consequently from her relationship, with her boyfriend Henry. On learning about
Heathers pregnancy, Henry terminates the relationship and leaves town leaving
Heather to bear the burden individually. Her problems are compounded by the fact
that, she was diagnosed with Rheumatic Heart Disease while she was only ten years
old (Australian Institute of Health and Welfare, 2004). The social pressure for her can
be presumed stretched to its limits coupled that this is her first pregnancy, and that she
has a heart disease problem which could prove fatal to her or the baby she is carrying.
In addition, she lacks crucial information regarding her condition and what it means
for her pregnancy, and therefore requires all the social support from her extended
family and friends, to successfully carry her pregnancy to the full term without
jeopardising her life or that of the foetus.
Cardiovascular diseases (CVD) can be categorised as rheumatic heart disease,
congenital heart disease, coronary heart disease, hypertension among others which
present numerous risks to patients both male and female, many at times putting their
lives at risks. A woman with a history of heart disease, especially rheumatic fever or
heart disease and is pregnant, should have access to appropriate health care services,
as the condition is dire to her health. Alizzi, (2010) demonstrates that cardiac diseases
are known to complicate pregnancies among women at a rate of 1% to 4% who do not

Rheumatic Heart Disease In Pregnancy

have pre-existing cardiac abnormalities. Therefore, women with pre-existing heart

problems require counselling in advance pertaining to the risk of the pregnancy.
Rheumatic heart disease or congenital heart disease defects in women with histories
of heart problems, like Heather, require proper health care and assistance, because
they are likely to experience pregnancy complications during birth. Pregnancies
normally change the working system of the heart and blood vessels, as the body
adapts to the requirements of a pregnant woman. Acute rheumatic fever still remains
prevalent across many regions of the world, and is usually the most common factor
contributing to heart diseases such as rheumatic heart disease, and proves to be critical
in the case of a pregnancy.

Epidemiology of Rheumatic Fever and Heart Disease

Rheumatic heart disease can be described as a condition where rheumatic fever causes
permanent damage in the heart valves. This disease prevents blood from flowing
backwards, because the heart valves structure is usually damaged with the progression
of rheumatic fever. Consequently, the infection starts as a throat infection caused by a
bacteria known as streptococcal (Ayoub, 2001 p.696). When this infection is not
treated, generally leads to rheumatic fever and repeated episodes may lead to
rheumatic heart disease. Rheumatic fever is an example of an inflammatory disease
that usually affects various connective tissues, which mostly include joints, heart,
brain or skin. More so, the disease can affect individuals at any age, but generally it is
common in children from five years of age to fifteen years.
Progression of rheumatic fever without proper treatment or medication, will
eventually lead to heart damage caused by rheumatic heart disease, which scars the
heart valves consequently forcing the heart to work above the normal rate, in pumping

Rheumatic Heart Disease In Pregnancy

blood that may further result to congestive heart failure. For Heathers case, it can be
presumed that she probably had RHD for quite some time, which can be attributed to
a history of acute rheumatic fever that went untreated (White, 2010). Symptoms of
rheumatic fever are experienced differently by individuals, but will usually be
manifested from the first to sixth week through strep throat.
Moreover, in some cases the infection is mild to be noticed or recognised. Further, a
heart affected by RHD results to heart valves that do not close completely causing
insufficiency, or do not open completely causing stenosis. Heart valves that do not
close properly, will allow leakage of blood back into the chamber from where it was
pumped. This condition is referred to as leakage or regurgitation, and consequently
with the next heart beat, the leaked blood mixes with the normal flow, thereby adding
more strain to heart muscles. It is advisable that pregnancy for a patient with severe
uncorrected mechanical heart valves, not to carry the pregnancy to term because the
foetal and maternal mortality and morbidity are high. For those who have milder
forms of the disease, pregnancy should proceed with regular health care and
monitoring while rectifying or stabilising the valvular lesion.

Pregnancy Factors
During pregnancy, a womans organic system is subjected to above normal
physiological modifications, attributed to the anatomic, hormonal and metabolic
alterations. The reason is because the womans body is adjusting, to the needs of the
pregnancy for both mother and child (Couzos, 2003). The major significant
modification is mostly observed in the circulatory system, where there is an amplified
cardiac output in the first three months of the pregnancy term. Women with histories
of cardiovascular disease may encounter severe complications, on the ongoing

Rheumatic Heart Disease In Pregnancy

process of gestation, attributed to the inappropriate body adaptation to the

hemodynamic overload for the needs of the pregnancy, which can also be experienced
by women who do not have pre-existing heart diseases, and who are thought to have
an appropriate functional capacity.
The strain of these physiological modifications and changes, combined with earlier
heart problems, can result to serious symptoms like headache, fatigue, shortness of
breath, chest pain or loss of concentration. In addition, pregnant women with existing
congenital heart disease may give birth to children with inherited heart defects
(Jackson, 2001, p.711). Tests should be conducted in the course of the pregnancy to
monitor the health of both the mother and the child. Jackson, (2010 p.711) continues
to indicate that in a normal pregnancy; a rise in blood volume of 40% to 50% is
experienced coupled by an increase in cardiac output of 30% to 50% above normal
rate, which are normally contributed by various factors such as rise in maternal heart
rate.
These factors are crucial for pregnant women because they influence the growth and
functional capacity of the foetal (Gregory, 1999 p.730). Hemodynamic changes are
profound during pregnancy term and more so during labour and delivery.
Consequently, during labour and delivery the cardiac output can rise above 75%
baseline, and this would severely affect a pregnant woman with a pre-existing heart
disease, because the cardiac output cannot perform to that level with defects,
consequently raising the morbidity and mortality of both the mother and the child.
Role of Nurses and Health Promotion Activities
Tests and monitoring are essential for pregnant women and especially teenage
pregnancies, through preconception care and prenatal care to monitor the health of
both the mother and the foetal (Allaire, 1998 p.164). It is important for couples to get

Rheumatic Heart Disease In Pregnancy

counselling before pregnancy especially for women with pre-existing heart disease, in
order to get the proper education and advice, concerning the risk factors that may
influence the pregnancy and how best to undertake the pregnancy. The life of the
mother and the foetus are usually at stake, when there is the prevailing element of a
heart condition.
Clinicians and nurses should consequently assist women with pre-existing heart
disease, by giving advice on contraception and health education regarding pregnancy
and what they should adapt to, in order to ensure a healthy lifestyle that will ensure
risks are reduced during pregnancy, followed by labour and delivery. In Heathers
case or teen pregnancies, should be handled by supportive nurses or physicians
because this being their first pregnancy, it is coupled by anxiety and stress which is
not healthy for the mother and the foetus. Proper counselling and risk stratification is
best undertaken before conception for women, in order to get updated information
concerning pregnancy and what is expected of them during this time. Teen
pregnancies moreover, are usually compounded by social pressures and relationships
which may not be supportive, leading to amplified strain for the pregnant teen as
many communities regard such pregnancies as inappropriate and untimely. This group
needs special support and counselling in order to carry their pregnancy to term with
minimum risks, to their health status.
Many of the symptoms in heart disease can be treated through lifestyle medicine and
modifications. A woman diagnosed with a pre-existing cardiovascular condition and
consequently taking medication before becoming pregnant, can work with nurses and
physicians to ensure that the medication is safe even during pregnancy (Russell, 1997
p.2788). Prenatal diagnosis of the RHD (Rheumatic Heart Disease) condition is vital
in the treatment of pregnant women. Sample DNA testing provides the results whether

Rheumatic Heart Disease In Pregnancy

the woman is RHD negative, and consequently eligible for Alloimmunisation

administration followed by anti D immunoglobulin, in preventing haemolytic diseases
for the newborn. After birth, vigilance would still be important in postnatal care and
monitoring through immune therapy and constant health checks. Promotional
activities for the health of the woman and the expected baby can entail, eating a
nutritious diet, quitting unhealthy habits such as drinking alcohol and smoking, and
consequently ensure that medication undertaken is approved by the doctor, which also
includes over the counter drugs (Briggs, 1998). A proper diet that is balanced is the
key to both the child and mother during pregnancy.
Moreover, the extra strain caused to the circulatory and heart system attributed to
pregnancy, can be reduced through adapting steps and methods to minimise stress and
anxiety by avoiding strenuous heat and activity, taking enough rest, taking iron
supplements in order to counter anaemia, and further being aware or alert to signs of
heart failure that can include tiredness, difficulties in breathing, or coughing fits. The
pregnant woman should not hesitate to attend a health institution if she feels abnormal
strain or condition, which can be detrimental if ignored repeatedly. The strain of
pregnancy can lead to other heart problems like arrhythmias, high blood pressure, and
heart murmurs.
Heart murmurs and arrhythmias are attributed to pregnancy complications that do not
usually require treatment, but high blood pressure should not be ignored as it indicates
on-set of other complications, which can be as a result of previous medical conditions.
Conclusion
Rheumatic fever and rheumatic heart condition in pregnant women, presents a risky
condition with the likelihood of pregnancy complications, because of the heart
defects. The epidemiology of rheumatic fever and rheumatic heart disease, indicates

Rheumatic Heart Disease In Pregnancy

that the streptococcus bacteria is responsible for rheumatic fever of which if it goes
untreated after sometime, consequently results to rheumatic heart disease.
Cardiovascular diseases for pregnant women, especially rheumatic heart disease and
congenital heart diseases have been studied to cause challenging complications during
pregnancy, and eventually during labour and delivery.
Prenatal and preconception care is vital for pregnant women, and the aspect of a heart
disease should be treated with utmost care from nurses and physicians. Counselling
and risk stratification is best done before pregnancy, especially with pre-existing or
hereditary heart disease condition, for the wellbeing of both the maternal and foetal
survivability. Promotional health activities are also essential for the pregnant woman
and the child, throughout pregnancy and eventual delivery.
Pregnant teens should be supported with proper advice from clinicians and nurses,
immediate family and overall community in order to successfully carry the pregnancy
to term, even when complicated pre-existing cardiovascular problems.

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References:
Australian Institute of Health and Welfare (AIHW).2004. Rheumatic Heart Disease:
All but forgotten in Australia except among Aboriginals and Strait Islander Peoples.
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2010)

Alizzi, A.M and Knight, J.L. 2010.Surgical challenges in rheumatic heart disease in
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Allaire A.D and Cefalo R.C.1998. Preconception health care model. European Journal
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Ayoub, E.M.2001.Acute rheumatic fever and poststreptococcal reactive arthritis.

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Briggs, G.G, Freeman R.R.1998. Drugs in Pregnancy and Lactation: A Reference

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Couzos Sophia and Carapetis, J. Rheumatic fever In.2003.Aboriginal Primary Health

Care: An Evidence-based Approach. (2nd Ed). Melbourne. Oxford University Press

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Jackson, M. Colman and Samuel, C. Siu. 2001. Congenital Heart Disease: Heart
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Russell, Raymond. Pregnancy and Heart Disease.1997. Risk and predictors for
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