A structured evidence-based approach to decrease cardiovascular complications among pregnant women with reumatic disease: a pilot randomized controlled trial

Background: Recent reports from the developing world have documented rheumatic fever (RE) incidence rates as high as 206/100 000 and Rheumatic Heart Disease (RHD) prevalence rates as high as 18.6/1000. The high frequency of RHD in the developing world necessitates aggressive prevention and control measures. Aim: The aim of the study was to examine the effect of intensive antenatal follow up program on decreasing cardiovascular complications among rheumatic pregnant woman. Design: Randomized controlled trial. Setting: This study was conducted at El Kasr-EL Aini, maternity hospital- Cairo- University Hospitals. Sample: A total of 100 rheumatic pregnant women that attended the antenatal clinic at El Kasr-EL Aini, maternity hospital who could read and write, had functional class I and II cardiac disease, primigravida, nullipara with single fetus were recruited to this study and assigned randomly into two groups. Procedure: Women who met the inclusion criteria were interviewed and baseline assessment was done. The intervention was an intensive antenatal follow up program for decreasing cardiovascular complications among rheumatic pregnant woman. Patients in the study group (SG) were offered an intervention at three levels, basic, intermediate and comprehensive. Evaluation of the program was carried out in term of assessment of maternal and neonatal outcome. Results: There were several significant differences between the study group (SG) and control group (CG). In the SG, antepartum complications was less common, gestational age at birth was higher, postnatal hospital stay shorter, birth weight higher, more had vaginal deliveries with episiotomy, fewer had caesarean section, forceps deliveries and termination of pregnancy, and cardiac class was better at follow up as compared to the CG. Conclusion: The difficult issues in pregnancy complications by cardiac disease are best managed through a team approach. Establishing a pre-pregnancy plan will foster a better therapeutic relationship between all parties and allow for better understanding of the patient’s beliefs regarding pregnancy, her disease and attitude towards medications.