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

Arquivos brasileiros de cardiologia, 2019-12, Vol.113 (6), p.1062-1069 [Peer Reviewed Journal]

This work is licensed under a Creative Commons Attribution 4.0 International License. ;ISSN: 0066-782X ;ISSN: 1678-4170 ;EISSN: 1678-4170 ;DOI: 10.5935/abc.20190197 ;PMID: 31596322

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Title:
Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge
Author: Avila, Walkiria Samuel ; Ribeiro, Veronica Martins ; Rossi, Eduardo Giusti ; Binotto, Maria Angelica ; Bortolotto, Maria Rita ; Testa, Carolina ; Francisco, Rossana ; Hajjar, Ludhmilla Abraão ; Miura, Nana
Subjects: Adolescent ; Adult ; CARDIAC & CARDIOVASCULAR SYSTEMS ; Congenital/complications Maternal Mortality ; Female ; Fetal Mortality ; Gestational Age ; Heart Defects ; Heart Defects, Congenital - classification ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - physiopathology ; Humans ; Infant, Newborn ; Maternal and Fetal Outcomes ; Maternal Mortality ; Original ; Pregnancy ; Pregnancy Complications, Cardiovascular - classification ; Pregnancy Complications, Cardiovascular - diagnosis ; Pregnancy Complications, Cardiovascular - mortality ; Pregnancy Complications, Cardiovascular - physiopathology ; Prognosis ; Young Adult
Is Part Of: Arquivos brasileiros de cardiologia, 2019-12, Vol.113 (6), p.1062-1069
Description: 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. To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. 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. 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. 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.
Publisher: Brazil: Sociedade Brasileira de Cardiologia - SBC
Language: English;Portuguese
Identifier: ISSN: 0066-782X
ISSN: 1678-4170
EISSN: 1678-4170
DOI: 10.5935/abc.20190197
PMID: 31596322
Source: SciELO
Geneva Foundation Free Medical Journals at publisher websites
MEDLINE
PubMed Central
Alma/SFX Local Collection
DOAJ Directory of Open Access Journals

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

This work is licensed under a Creative Commons Attribution 4.0 International License. ;ISSN: 0066-782X ;ISSN: 1678-4170 ;EISSN: 1678-4170 ;DOI: 10.5935/abc.20190197 ;PMID: 31596322

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