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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.

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The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.

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Objectives: To describe the clinical features, obstetric and perinatal outcomes of pregnancies in patients diagnosed Takayasu arteritis associated to arterial hypertension. Methods: A retrospective, observational and descriptive study evaluating pregnant patients at a Brazilian tertiary hospital between the years 2002 and 2016 that had been diagnosed with Takayasu arteritis (TA) based on the modified Ishikawa criteria. Arterial hypertension (AH) previous to pregnancies was considered as BP≥ 140/90 mmHg or under treatment. The variables considered for analysis were clinical characteristics, diagnostic criteria, obstetrics and perinatal outcomes of these pregnancies. Results: Twenty-nine pregnancies in 24 patients were followed in the period. Hypertension was detected in 20 patients (83.3%). The most prevalent angiographic criteria were injury in the abdominal aorta, found in 15 women (62.5%). Angiographic classification type 5 was the most common feature. Aside from two drop-outs that were not followed up, the pregnancies resulted in 25 live births. Five (20%) of the newborns were classified as small for gestational age and eight (32%) were premature, most of them in patients with AH. Eighteen deliveries (69.2%) were caesarean sections and the main anesthetic method was the combined spinal-epidural. Preeclampsia was the main maternal complication, present in five cases, all of them with previous diagnosis of AH. There were no acute cardiovascular complications during pregnancy related to underlying disease. The only fetal death in this study was an abortion after judicial authorization by lethal fetal malformation. Conclusion: In general, patients with TA had a good perinatal outcomes despite of severity of disease. Hypertension is highly prevalent and is related to major reported obstetric and perinatal complications, such as preeclampsia, prematurity and newborns that are small for gestational age.