Pregnancy in women with congenital heart disease: General principles
- Carol A Waksmonski, MD
Carol A Waksmonski, MD
- Professor of Medicine
- Columbia University Medical Center
- Michael R Foley, MD
Michael R Foley, MD
- University of Arizona College of Medicine - Phoenix
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
Progress in medical and surgical treatment has resulted in larger numbers of women with congenital heart disease surviving to child-bearing years and proceeding with pregnancy .
The general principles of management of pregnancy and contraception in women who have unrepaired or repaired congenital malformations of the heart or great vessels will be reviewed here. Pregnancy in women with specific congenital cardiac anomalies, the management of valvular heart disease during pregnancy, and the management of heart failure and arrhythmias during pregnancy are discussed separately. (See "Pregnancy in women with congenital heart disease: Specific lesions" and "Pregnancy and valve disease" and "Management of heart failure during pregnancy" and "Supraventricular arrhythmias during pregnancy" and "Ventricular arrhythmias during pregnancy".)
Successful cardiac surgery improves fertility and reduces the maternal and fetal risk of pregnancy in women with congenital heart disease [2,3]. Accordingly, women are now presenting for obstetric and cardiologic care after reparative cardiac surgery . In a registry of the European Society of Cardiology, congenital heart disease was the most prevalent form of structural heart disease (66 percent) affecting pregnancy outcomes worldwide .
Congenital heart disease remains an important cause of maternal mortality and morbidity during pregnancy. The magnitude of risk is illustrated by the following observations:
●In a report of maternal deaths from 2000 to 2002 in the United Kingdom, cardiac disease was the second most common cause, with congenital heart disease accounting for 20 percent of cardiac deaths .
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- CARDIOVASCULAR CHALLENGES DURING PREGNANCY
- Hemodynamic changes
- Risk of thromboembolism
- MATERNAL RISK STRATIFICATION
- Maternal cardiovascular risk assessment
- - Overview
- - Modified WHO classification
- - ZAHARA score
- - CARPREG risk score
- Individual risk factors
- - Pulmonary hypertension
- - Cyanosis
- - Maternal functional class
- - Aortic disease
- - Natriuretic peptide levels
- FETAL RISK
- Risk assessment
- - Maternal functional class
- - Maternal cyanosis
- - Inheritance
- PRECONCEPTION AND PRENATAL CARE
- Preconception or initial evaluation
- Intervention prior to pregnancy
- Prenatal care
- Fetal evaluation
- PREGNANCY TERMINATION
- MANAGEMENT OF LABOR, DELIVERY, AND THE POSTPARTUM PERIOD
- - Anesthesia and hemodynamic monitoring
- - Fetal monitoring
- - Oxygen therapy
- - Preterm labor
- Role of cesarean delivery
- Postpartum care
- Ovarian function