Rheumatic Heart Disease in Pregnancy
The best way to make sure a woman with RHD has a healthy pregnancy for her and her baby is early diagnosis and cardiac review, collaborative care and communication with family, health workers, maternity and cardiac services.
Pregnancy can provide a critical point in time to pick up previously undiagnosed RHD.
“Rheumatic heart disease may be silent. It’s very important when you’re encountering high-risk individuals is to think of rheumatic heart disease and to screen for rheumatic heart disease by listening to the individual’s heart. If there is a cardiac murmur, to request a prompt echocardiogram. This will really help you to plan the journey of pregnancy, and to come up with the best place to deliver the baby. The highest risk woman in Australia are the Indigenous people, Maori Pacific Islanders and refugees.” Dr Bo Remenyi
Apart from missed diagnosis of RHD, other barriers to optimal care can include access to health (particularly cardiac) services, travel and birthing away from Country, with impact on the woman, her family and community.
“One of the problems is that people might live a long way away from the major centre, hundreds of kilometres away in some cases. There might be all sorts of barriers like a language barrier. They might not have very good English. They might be very shy. They might not be used to travelling to a major city or a major centre. There are all sorts of reasons why it might be difficult to deliver the sorts of medical care to that pregnant woman that she actually needs. We do see that. There are sad cases where people fall through the gaps even with all best intentions.” Dr Jessie Johnson
“[Where there is} severe RHD or mechanical valves, it’s critical to consult your doctor when you’re planning to fall pregnant – so, before conception. This way, the patient, the doctor and the health workers can have a relationship to decide the best pathway”. Dr Bo Remenyi
Many women with RHD have healthy journeys through pregnancy with good outcomes for them and their babies.
“I thought, at first, as I was going through my pregnancy, I thought that I was going to have problems delivering my son. I was scared at first. Then, the doctor said to me, “I think you shouldn’t be scared.” Whilemena, Tiwi Islands
REMEMBER… Rheumatic Heart Disease in Pregnancy
Girls are almost twice as likely to get RHD as boys.
Women are at higher risk during pregnancy because the heart of a women carrying a baby is working harder than normal.
Pregnant women who could have RHD should get checked at the clinic as early in the pregnancy as possible.
If a woman is prescribed secondary prophylaxis (usually LA Bicillin injections every 21-28 days) it’s essential that she gets the treatment ON TIME, EVERY TIME. This treatment is safe and will not harm the baby in anyway.
It’s especially important for women on anticoagulation therapy (eg Warfarin, Coumarin) to have early – and ongoing – review during pregnancy.
Preconception counselling is important and can include talking about planning to become pregnant, the time between pregnancies, and possible timing of cardiac surgery and other treatment.
Please watch Take Heart Short Film Staying on Track with Secondary Prophylaxis
TWEET IT OUT ‘#takeheartmovie RHD in Pregnancy. Stay on track. Get your injections on time or early’
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The Australasian Maternity Outcomes Surveillance System (AMOSS) contributes support to the Moonshine Take Heart film on RHD in pregnancy under its funding by the National Health and Medical Research Council (NHMRC)