Pregnancy Complications Diagnosis

Case Presentation

• 35-year-old Indian housewife, Mrs. Dewi, is 24 weeks pregnant and experiencing shortness of breath, fatigue, and bilateral ankle swelling over the past few weeks.
• She felt her heart racing, severe shortness of breath, and coughed up pink frothy sputum on the day of admission to the hospital.

Medical History

• No known medical illness prior to pregnancy
• History of sore throats as a child, but no specific history of rheumatic fever
• Four previous pregnancies with no complications

Rheumatic Heart Disease

Pathophysiology

• Caused by autoimmune reaction to Group A beta-hemolytic streptococcus (streptococcus pyogenes) resulting in valvular damage
• Characterized by repeated inflammation with fibrinous repair
• Cardinal anatomic changes of the valve: leaflet thickening, commisural fusion, and shortening and thickening of tendinous cords

Signs and Symptoms

• Migratory polyarthritis of the large joints
• Pancarditis
• Subcutaneous nodules
• Erythema marginatum of the skin (non-itchy)
• Sydenham chorea (neurologic disorder with involuntary rapid, purposeless movements)
• Fever
• Multiple painful joints
• Heart involvement in half of the cases, usually in people between 5-14 years old

Diagnosis

• Auscultation – S1 snap
• Echocardiography (more sensitive) to detect signs of rheumatic heart disease before obvious symptoms
• Elevated antistreptolysin O titre or anti-DNase B to test for presence of GAS
• Signs of preceding streptococcal infection: scarlet fever, raised ASOT or other streptococcal antibody titre, positive throat culture
• Revised Jones criteria: diagnosis made when 2 major criteria, or one major criterion plus 2 minor criteria are present along with evidence of streptococcal infection