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March 9, 2017

Severe Heart Disease and Pregnancy: the Courage of Wanjiku

A recent and ongoing patient encounter that I have is very inspiring. She is a patient who has an acquired severe heart disease. She has been on follow-up in the heart clinic for over 7 years.

Despite being discouraged from getting pregnant, she indeed presented with pregnancy at 7 weeks with features of the heart problem more aggravated into a stroke. She could not speak nor walk.

A joint team of heart specialists, Obstetrician gynecologists, social scientists and other experts all concurred that the pregnancy posed a grave danger to her life and should be terminated as provided by the law in the interest of mothers health.

Being among the team we all signed as required in concurrence. To our utter dismay, the young lady who had already suffered a stroke as part of the complications of heart disease aggravated by pregnancy, elected to continue the pregnancy supported by her equally young partner.

Despite my ambivalence and quite optimism, I quickly convinced my colleagues that in that case then we continue to provide the best medical care available having, reached the end of current evidence. This is line with the Hippocratic Oath where patient autonomy is paramount.

This was 28 weeks ago. Now Wanjiku is at 34 weeks, only Six weeks to GO! .Ultrasound shows the baby is growing well. Her overall condition has markedly improved as well. She is now able to communicate verbally and to move without support, all this was not there at admission. Her constant smile and positive energy is evident as you walk into room 3 on one of the ground floor wards.

Our fingers are crossed as the expected date approaches. We are constantly able to adequately assess her and her developing baby’s risk moving forward in this pregnancy. More than 1 in 4 maternal deaths are caused by pre-existing medical conditions such as diabetes, Heart Disease, HIV, malaria and obesity, whose health impacts can all be aggravated by pregnancy

Heart disease is encountered in nearly 1% of pregnancies, and the incidence is increasing. This is likely due to advances in cardiac management over the past 25 years, particularly advances in cardiac surgery and drugs, which have allowed more women with congenital and other abnormalities not only to survive to reach the age of child-bearing but also to carry a pregnancy to term successfully

Given the potential complications associated with maternal heart disease, the ability to both counsel patients prior to pregnancy and appropriately manage patients during pregnancy is of vital importance. The complexity of these patients requires a multidisciplinary approach with the involvement of obstetricians, cardiologists, anesthesiologists, and internists who are experienced in caring for these patients.

The new data show a changing profile in the conditions that cause maternal deaths; reflecting the increasing burden of noncommunicable diseases in women throughout the world. Ending preventable maternal deaths will require both continued efforts to reduce complications directly related to pregnancy, and more of a focus on non-communicable diseases and their effect in pregnancy.

I salute Wanjiku for her bravery.

She has literally put her life on line for her baby!

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