{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T11:38:56Z","timestamp":1765280336485},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high\u2010income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower\u2010income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre\u2010existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9\u201338.0). Five women died. Cardiac events occurred in twenty\u2010two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35\/65, 53.8%) were using long\u2010acting reversible contraception.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite several barriers, it was possible to implement a multidisciplinary service in a high\u2010burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context\u2010specific guidelines and better detection of cardiac disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13804","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T09:27:51Z","timestamp":1659432471000},"page":"803-814","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Experiences of a dedicated Heart and Maternal Health Service providing multidisciplinary care to pregnant women with cardiac disease in a tertiary centre in Namibia"],"prefix":"10.1111","volume":"27","author":[{"given":"Steffie","family":"Heemelaar","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Windhoek Central Hospital  Windhoek Namibia"},{"name":"Department of Obstetrics and Gynaecology  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ndatiyaroo","family":"Agapitus","sequence":"additional","affiliation":[{"name":"Department of Cardiology Windhoek Central Hospital  Windhoek Namibia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology  Leiden The Netherlands"},{"name":"Athena Institute VU University  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University Medical Center Groningen  Groningen The Netherlands"},{"name":"Department of Obstetrics and Gynaecology Medical Center Leeuwarden  Leeuwarden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shonag","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Windhoek Central Hospital  Windhoek Namibia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Hugo\u2010Hamman","sequence":"additional","affiliation":[{"name":"Department of Cardiology Windhoek Central Hospital  Windhoek Namibia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tangeni","family":"Auala","sequence":"additional","affiliation":[{"name":"Department of Cardiology Windhoek Central Hospital  Windhoek Namibia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,18]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"KnightM BunchK TuffnellD Jayakody H Shakespeare J Kotnis R et al.Saving lives improving mothers' care\u2014lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2014\u201316. 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