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Pregnancy in women with congenital heart disease: Specific lesions

Authors
Carol A Waksmonski, MD
Michael R Foley, MD
Section Editors
Charles J Lockwood, MD, MHCM
Heidi M Connolly, MD, FASE
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Risks associated with pregnancy in women with congenital heart disease affect both the mother and her fetus. The obstetrician and cardiologist are therefore responsible for the welfare of two patients.

The focus here is on management of pregnant women with specific congenital cardiac anomalies, both unrepaired and after reparative surgery. Other issues such as maternal risks, oxygen delivery, and management during labor and postpartum are discussed separately. (See "Pregnancy in women with congenital heart disease: General principles".)

Certain lesions such as coarctation of the aorta, tetralogy of Fallot, and Marfan syndrome are discussed elsewhere. (See "Management of coarctation of the aorta", section on 'Pregnancy' and "Management and outcome of tetralogy of Fallot", section on 'Pregnancy' and "Pregnancy and Marfan syndrome".)

Also covered separately are general cardiac issues concerning the management of arrhythmias, heart failure, valvular heart disease, and anticoagulation during pregnancy. (See "Supraventricular arrhythmias during pregnancy" and "Ventricular arrhythmias during pregnancy" and "Management of heart failure during pregnancy" and "Pregnancy and valve disease" and "Use of anticoagulants during pregnancy and postpartum".)

GENERAL MATERNAL AND FETAL RISKS

Reparative surgery has substantially increased the number of females with congenital heart disease who reach childbearing age. A study showed that the number of delivery hospitalizations with congenital heart disease increased significantly from 6.4 to 9 per 10,000 deliveries from 2000 to 2010 and that these deliveries had a greater than expected rate of medical and obstetric complications [1]. Successful operation before gestation is pivotal in reducing maternal and fetal risks. The risks of pregnancy after congenital cardiac surgery are determined chiefly by the presence, type, and degree of cardiac and vascular residua and sequelae.

                  

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 02 00:00:00 GMT 2016.
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