Unique Prospective Cohort Study: Rheumatic Heart Disease (RHD) and Pregnancy<br />

Background: An increased cardiac workload in pregnancy can unmask undiagnosed RHD and exacerbate clinical symptoms in women with RHD. Pregnant women with mechanical heart valves who require therapeutic anticoagulation throughout pregnancy; women with mitral or aortic stenosis; or with severe RHD, are at particular risk. There is a paucity of clinical research about RHD in pregnancy with most recommendations based on generic studies of severe disease in non-pregnant adults or women with congenital cardiac disease.A two-year study of the prevalence, management and outcomes of RHD in pregnancy across Australia and New Zealand has commenced as part of the Australasian Maternity Outcomes Surveillance System (AMOSS), a bi-national surveillance/research system of rare or serious conditions in pregnancy, childbirth and the post natal period. In New Zealand, AMOSS is run under the auspices of the Perinatal and Maternal Mortality Review Committee (PMMRC).Methods: We have developed a prospective cohort study to identify and collect data from every pregnant woman with RHD presenting at one of 300 maternity units in Australia and New Zealand. The content of the extensive data collection tools includes RHD history, clinical changes over the duration of the pregnancy, echocardiographic findings, anticoagulation regimens and delivery and neonatal outcomes.Results: In the initial six months of data collection we have been notified of 40 cases suggesting that 60&ndash;80 cases may be identified annually in New Zealand.Conclusion: This prospective cohort study allows a unique opportunity to gather information of maternal and infant outcomes in this serious condition