Fetal Mortality – ABC CARDIOL

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Editorial

Complex Congenital Heart Diseases and Pregnancy: Maternal and Fetal Risks

The diagnosis and treatment of congenital heart disease has made remarkable progress in recent decades and the success of this approach is evidenced by the increasing number of adults with congenital heart disease. Many of these patients have residual injuries or have undergone palliative surgery and face additional challenges in adulthood, requiring integrated care to reach a full life potential.

Consequently, the number of women of childbearing age with congenital disease submitted to surgical repair, palliative procedure or the natural evolution of the disease is increasing, with a higher maternal and fetal risk in the presence of heart disease. Reproductive counseling is essential, by informing the consequences and possible complications and advising against pregnancy in the presence of more complex defects.

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Original Article

Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge

Walkiria Samuel Avila et al. Veronica Martins Ribeiro Eduardo Giusti Rossi Maria Angelica Binotto … Maria Rita Bortolotto Carolina Testa Rossana Francisco Ludhmilla Abraão Hajjar Nana Miura

Abstract

Background:

The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions.

Objectives:

To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis.

Methods:

During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05.

Results:

Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia.

Conclusions:

Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.