Obstetric and perinatal aspects in patients with congenital heart diseases

Abstract

The benefits of surgical treatment for patients with congenital heart disease in relation to pregnancy are still controversial. We studied 48 pregnant women (mean age = 25 years) with surgically-corrected congenital heart diseases (Group 1). This included 15 cyanotic diseases: Fallot's tetralogy (11 cases); Ebstein's anomaly (2 cases); transposition of the great arteries (1 case); and double outlet of the right ventricle (1 case). We compared them to 52 pregnant women (mean age = 26 years) with untreated congenital heart diseases, which included 11 cases of Eisenmenger's syndrome (Group 2). Group 2 showed a higher incidence of maternal death (12 vs. 0 percent; p=0.01), perinatal mortality (15 vs. 0 percent; p=0.01) and prematurity (32 vs. 7 percent; p=0.01). Spontaneous abortion (4 vs. 10 percent), Caesarean deliveries (48 vs. 66 percent) or growth retardation (13 vs. 28 percent) did not present any significant differences between these groups. Surgical treatment in patients with heart diseases is associated with a better maternal and fetal prognosis. Therefore, surgery must be considered when counseling patients with congenital heart diseases.

Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect

“…3,4 In the present study we found a low rate of cardiac events during pregnancy, which is in agreement with the small amount of existing literature. [5][6][7][8] The risk of obstetric events was associated with the corrective status. The presence of an unrepaired VSD was associated with a higher risk of pre-eclampsia (8.7%).…”

“…3,4 Despite the fact that a VSD is one of the most common forms of heart disease among pregnant women, VSD-specific pregnancy data are limited. [5][6][7][8] A recent literature review of studies published between 1985 and 2007 found a total of 83 completed pregnancies among women with VSDs (combining repaired and unrepaired VSD). 9 The current consensus is that pregnancy in women with an isolated VSD is generally well tolerated, with no maternal mortality and no significant maternal or fetal morbidity.…”

Pregnancy and the cardiovascular system

“…In one study, untreated patients had a higher maternal death (12% vs. 0%), perinatal mortality (15% vs. 0%), and prematurity (32 vs. 7%) than those who were surgically corrected [30].…”

Outcome of Pregnancy in Women With Congenital Heart Disease

“…AOS ϭ aortic stenosis; ASD ϭ atrial septal defect; AVSD ϭ atrioventricular septal defects; CC-TGA ϭ congenital corrected transposition of the great arteries; CHD ϭ congenital heart disease; CoA ϭ aortic coarctation; Ebstein ϭ Ebstein's anomaly; Eisenmenger ϭ Eisenmenger syndrome; Fontan ϭ patients after Fontan repair; PAVSD ϭ pulmonary atresia with ventricular septal defects; PS ϭ pulmonary valve stenosis; TGA ϭ complete transposition of the great arteries; TOF ϭ tetralogy of Fallot; VSD ϭ ventricular septal defect. Ebstein (9,10,20,27,35,36) Eisenmenger ( to intervene in women with CHD. A high incidence of premature rupture of membranes may have played a role in patients with TGA and Fontan.…”