Title : Enhancing maternal and fetal outcomes: The role of routine antenatal echocardiography in high-prevalence areas of rheumatic heart disease
Abstract:
Background: Rheumatic heart disease (RHD) is a leading cause of valvular heart disease globally, particularly in low- and middle-income countries, where it significantly contributes to non-obstetric maternal morbidity and mortality. Echocardiography has emerged as a promising tool for early detection, yet its integration into routine antenatal care remains understudied.
Methods: A systematic review was conducted to evaluate the role of transthoracic echocardiography, including handheld devices, in screening pregnant women in RHD-endemic regions. Searches in MEDLINE and Embase yielded 10 observational studies involving 23,166 women. Key outcomes included prevalence of RHD and other cardiac abnormalities, severity stratification, maternal-fetal complications, and diagnostic feasibility.
Results: The prevalence of RHD varied widely across studies (0.4%–6.6%; I² > 90%), with mitral valve involvement being predominant. Handheld echocardiography demonstrated potential for detecting subclinical and clinically significant RHD, as well as other abnormalities, such as left ventricular systolic dysfunction (<0.5%) and congenital defects (1%–2%). Despite its diagnostic utility, limitations included very low certainty of evidence, lack of comparator trials, and inconsistent diagnostic criteria.
Conclusion: Antenatal echocardiographic screening in high-prevalence regions has the potential to improve maternal and neonatal outcomes by facilitating early diagnosis and management. However, significant gaps exist regarding its cost-effectiveness, optimal timing, and implementation strategies. Further high-quality, controlled studies are essential to validate these findings and guide WHO recommendations.
