Pregnancy in women with congenital heart disease: Specific lesions
- 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
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 . A review reported that congenital heart disease now comprises 80 percent of all pregnancies in women with heart conditions in the Western world . 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL MATERNAL AND FETAL RISKS
- INTRACARDIAC SHUNTS
- Ostium secundum ASD
- Ventricular septal defect
- Atrioventricular septal defect
- Cyanotic congenital heart disease
- PATENT DUCTUS ARTERIOSUS
- EISENMENGER SYNDROME
- CONGENITAL AORTIC DISEASE
- UNCOMMON CONGENITAL CARDIAC DEFECTS IN PREGNANT WOMEN
- Complete heart block
- Ebstein's anomaly
- Congenitally corrected transposition of the great arteries
- D-Transposition of the great arteries
- Single ventricle, unrepaired
- - Tricuspid atresia
- - Repaired functional single ventricle
- SUMMARY AND RECOMMENDATIONS