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Outcome of pregnancy in women with congenital heart disease

Published online by Cambridge University Press:  19 August 2008

A. A. Schmaltz ,
U. Neudorf  and
U. H. Winkler
A. A. Schmaltz*
Affiliation:
Department ofPaediatric Cardiology, Children's Hospital, and Department of Obstetrics and Gynaecology, University Hospital Essen, Germany
U. Neudorf
Affiliation:
Department ofPaediatric Cardiology, Children's Hospital, and Department of Obstetrics and Gynaecology, University Hospital Essen, Germany
U. H. Winkler
Affiliation:
Department ofPaediatric Cardiology, Children's Hospital, and Department of Obstetrics and Gynaecology, University Hospital Essen, Germany
*
Prof. Dr. A. A. Schmaltz, Dept. of Paediatric Cardiology, University Children's Hospital, Hufelandstr. 55, D-45122 ESSE, Germany. Tel: 201–723–2452; Fax: 201–723–5743
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Abstract

Improvements in diagnosis and surgical technique for correction have led to an increasing number of women with congenital heart disease reaching the child-bearing age. Pregnancy places considerable strain on the heart and circulation and necessitates marked cardiorespiratory adaptation. Today, with the exception of the Eisenmenger syndrome, there is no increased mortality associated with pregnancy in congenital heart disease. In contrast, there is still considerable morbidity, due to congestive heart failure, thromboembolic complications and disturbances of rhythm.

Fetal outcome is complicated by a high rate of spontaneous abortions (20–25%), retardation of fetal growth, and premature delivery (almost 100% in cyanotic mothers). Based on an extensive review of the literature, we discuss the specific risks in pregnancy depending on the hemodynamic situations produced by different heart defects. We also discuss the risks and advantages of different regimens for anticoagulation.

Counselling concerning contraception is frequently inadequate. The most important problems are thromboembolic complications with the use of hormonal contraception, and hyper- and dysmenorrhea in those using intrauterine devices. Finally, the genetic risks must be considered, differentiating between single gene defects and the sex of the parents suffering from congenital heart diseases.

Keywords

Pregnancycongenital heart diseasematernal riskfetal riskanticoagulationgenetic risk
Type
Continuing Medical Education
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 88 - 96
Copyright
Copyright © Cambridge University Press 1999

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