Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge
Abstract Background: 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. Obj...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cardiologia (SBC)
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| Series: | Arquivos Brasileiros de Cardiologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2019005019101&lng=en&tlng=en |
| _version_ | 1818147850148642816 |
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| author | Walkiria Samuel Avila Veronica Martins Ribeiro Eduardo Giusti Rossi Maria Angelica Binotto Maria Rita Bortolotto Carolina Testa Rossana Francisco Ludhmilla Abraão Hajjar Nana Miura |
| author_facet | Walkiria Samuel Avila Veronica Martins Ribeiro Eduardo Giusti Rossi Maria Angelica Binotto Maria Rita Bortolotto Carolina Testa Rossana Francisco Ludhmilla Abraão Hajjar Nana Miura |
| author_sort | Walkiria Samuel Avila |
| collection | DOAJ |
| description | Abstract Background: 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. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: 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. Results: 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. Conclusions: 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. |
| first_indexed | 2024-12-11T12:41:48Z |
| format | Article |
| id | doaj.art-a7fa4c97c3354d3481d55d6c2e7cec94 |
| institution | Directory Open Access Journal |
| issn | 1678-4170 |
| language | English |
| last_indexed | 2024-12-11T12:41:48Z |
| publisher | Sociedade Brasileira de Cardiologia (SBC) |
| record_format | Article |
| series | Arquivos Brasileiros de Cardiologia |
| spelling | doaj.art-a7fa4c97c3354d3481d55d6c2e7cec942022-12-22T01:06:56ZengSociedade Brasileira de Cardiologia (SBC)Arquivos Brasileiros de Cardiologia1678-417010.5935/abc.20190197S0066-782X2019005019101Pregnancy in Women with Complex Congenital Heart Disease. A Constant ChallengeWalkiria Samuel AvilaVeronica Martins RibeiroEduardo Giusti RossiMaria Angelica BinottoMaria Rita BortolottoCarolina TestaRossana FranciscoLudhmilla Abraão HajjarNana MiuraAbstract Background: 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. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: 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. Results: 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. Conclusions: 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2019005019101&lng=en&tlng=enPregnancyHeart DefectsCongenital/complications Maternal MortalityFetal MortalityMaternal and Fetal Outcomes |
| spellingShingle | Walkiria Samuel Avila Veronica Martins Ribeiro Eduardo Giusti Rossi Maria Angelica Binotto Maria Rita Bortolotto Carolina Testa Rossana Francisco Ludhmilla Abraão Hajjar Nana Miura Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge Arquivos Brasileiros de Cardiologia Pregnancy Heart Defects Congenital/complications Maternal Mortality Fetal Mortality Maternal and Fetal Outcomes |
| title | Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge |
| title_full | Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge |
| title_fullStr | Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge |
| title_full_unstemmed | Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge |
| title_short | Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge |
| title_sort | pregnancy in women with complex congenital heart disease a constant challenge |
| topic | Pregnancy Heart Defects Congenital/complications Maternal Mortality Fetal Mortality Maternal and Fetal Outcomes |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2019005019101&lng=en&tlng=en |
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