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Rheumatic Heart Disease and Pregnancy


Rheumatic heart disease occurs when damage to one or more heart valves after one or more episodes of acute rheumatic fever. It is accounts for 1.5% of deaths in Thai population. Rheumatic fever can occur after an infection of the throat with a bacterium called group A streptococcus. The infection is common in children and the damage to heart valves might not show any symptoms for many years. Diagnosis may not occur until the time of pregnancy. The added stress on the heart can result in symptomatic rheumatic heart disease where previously there were no symptoms.

An example case is a 21 year old pregnant woman from Nauru. She was referred to Bangkok hospital due to rheumatic heart disease during her pregnancy. She thought that she might not be able to keep the baby. However, after consultations with a team consisting of an obstetrician, a cardiologist, and a pediatrician, the doctors agreed that termination of pregnancy is not required. With careful planning, monitoring, and support, she was able to continue with the pregnancy and a healthy baby was born. After the delivery, the mother had a heart valve surgery and was fully recovered.
Therefore, women suffering from rheumatic heart disease are able to conceive with careful preconception planning and care.  The outcome of pregnancy can improve both for the mother and the baby through careful monitoring and support during pregnancy.
What is rheumatic heart disease?

Rheumatic heart disease is chronic damage to the valves of the heart, caused by episodes of acute rheumatic fever. Rheumatic fever usually occurs in children aged 5-15 while rheumatic heart disease is most commonly seen in adolescents and young adults. Rheumatic heart disease is a burden in developing countries and underprivileged communities.

Symptoms are:

  • Fever, joint pain
  • Skin rash, lumps under the skin
  • Jerky movements
  • Fatigue, chest pain, swelling (edema), breathlessness
  • Chronic inflammation of the heart which may lead to heart failure or even death.
Pregnancy risk in rheumatic heart disease patient
  • Maternal and neonatal death
  • Preterm delivery
  • Heart failure in late pregnancy, during delivery, and post-delivery
  • Increased risk of complications
Managing rheumatic heart disease during pregnancy
  • Early assessment of risk and regular monitoring helps reduce several risks during pregnancy
  • If there are symptoms of acute rheumatic fever, consult a doctor immediately.
  • Take medications as prescribed by the doctor
Babies in need of specialized care

Babies born prematurely or with health concerns, the first 4 hour is critical, as their respiratory and circulation system have to work independently. During this time, close monitoring by a neonatal specialist is required.
From the example case, the mother from Nauru, the pregnancy was at risk for preterm delivery. A team of neonatal specialists, an obstetrician, and a cardiologist were well prepared to provide specialized care for the baby.
For women with rheumatic heart disease, careful preconception planning and care, monitoring and support during pregnancy, can improve outcomes for both the mother and the baby. Bangkok Hospital is ready with the most advanced technology, a team of medical experts and staff to provide the highest standard of care for babies with health concerns.

  • Dr. Rapin Kukreja, head of cardiologists, Bangkok Heart Hospital
  • Dr. Romsai Lerdpienpitayakul, Obstetrician, Women’s health center, Bangkok Hospital
  • Dr. Pornpat Pornladnun, Pediatrician, Pediatric center, Bangkok Hospital