PhD defence L. (Lucia) Baris

Maternal mortality is a major problem, of which the World Health Organization has incorporated the intended reduction as one of its Sustainable Development Goals. In parts of the world, maternal heart disease is now the most important cause of maternal death. However, not much is known about this subject and recommendations are mostly based on small studies. In this thesis, the pregnancy outcomes of women with all sorts of heart disease are investigated, using the international Registry Of Pregnancy And Cardiac disease (ROPAC) of the European Society of Cardiology. This is the largest study to date to investigate pregnancy outcomes in heart disease. The most important findings are that generally speaking, women with heart disease tolerate pregnancy well, with low risks of complications for both mother and child. However, there is a 0.6% maternal death rate, which is more than 100 times higher than that of healthy mothers. Also, heart failure is frequently encountered. These results are mostly the result of inclusion of very high-risk groups, in which pregnancy is considered contra-indicated. Therefore, it is very important to subject a woman to preconceptional counselling, in response to multidisciplinary team cconsultation, before embarking upon a pregnancy, to adequately inform her of the risks for her specific situation. Also, attention should be given to the way of giving birth. A vaginal birth is almost always indicated and is considered most safe for both mother and child. An important finding in this thesis is that the Caesarean section rate is way higher than needed.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall or in the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.