Background: Rheumatic heart disease (RHD) is a major cause of cardiovascular morbidity among Aboriginal and Torres Strait Islander peoples and disproportionately effects women of childbearing age. Pregnancy induces substantial haemodynamic changes that may exacerbate underlying valvular heart disease, increasing the risk of adverse outcomes. Contemporary data in Aboriginal Australian women with RHD remains limited. This case series aims to describe the pregnant women with RHD managed at a tertiary cardio-obstetric service.
Methods: We describe a retrospective cohort of pregnant women managed at Flinders Medical Centre with RHD from South Australia (SA) or the Northern Territory (NT) in 2025 and 2026.
Results: Thirteen pregnancies in 13 women (mean age 31±7 years) were identified. One hundred percent of patients had rheumatic mitral valve disease and 54% had dual mitral and aortic valve pathology. Sixty nine percent had high or extremely high maternal cardiovascular risk (modified World Health Organisation (mWHO) 2.0 class III or IV). Maternal cardiac events occurred in 31%, including heart failure decompensation (31%), arrhythmia (15%), and one patient underwent percutaneous valve intervention antenatally. All but one patient delivered via caesarean section. Sixty nine percent were pre-term deliveries, 15% of neonates were small for gestational age (SGA) and all required a neonatal intensive care admission. No maternal or neonatal deaths occurred.
Conclusion: Pregnancy in Aboriginal Australian women with severe RHD is marked by high cardiovascular risk and pre-term deliveries. With high rates of antenatal cardiac complications, a proactive, centralised cardio-obstetric service is essential to optimise maternal and neonatal outcomes.