Pregnancy in Women with Congenital Heart Disease: A Guide for the General Cardiologist

Abstract

Remarkable advances in the care and survival of congenital heart disease (CHD) patients have led to increasing numbers of young women with CHD who carry a pregnancy with significant risk. The profound hemodynamic changes that naturally occur during gestation may unmask CHD or exacerbate an existing condition and place both the woman and fetus in jeopardy. The caring cardiologist should be familiar with the specific lesion and anticipate complications. Pregestational counseling and a multidisciplinary team approach during pregnancy are key for a successful pregnancy and favorable outcomes. In this review we discuss the evaluation of the expecting CHD patient and focus on the commonly encountered lesions.

Maternal cardiac arrest secondary to choriosepsis after preterm premature rupture of membranes

“…Within the immediate postpartum period, autotransfusion can increase cardiac output by 60%-80%, with blood transferred from the uterus into systemic circulation. 13 In our case, we hypothesize that postpartum autotransfusion may have transiently counterbalanced the typical hypovolemic state of sepsis over the first 24-48 hours. Coupled with lipopolysaccharide release, these phenomena made it difficult to identify sepsis and treat aggressively, thus leading to critical decline.…”

Arrêt cardiaque maternel secondaire à une chorioamnionite compliquée d’une septicémie après rupture prématurée des membranes

“…Durant le postpartum immédiat, l'autotransfusion peut faire augmenter le débit cardiaque de 60 %-80 %, car le sang passe de l'utérus vers la circulation systémique 13 . Selon notre hypothèse, ici, l'autotransfusion postpartum peut avoir modifié provisoire ment l'hypovolémie typique de la septicémie au cours des 24-48 premières heures.…”

Maternal Health

“…A number of risk assessment tools have been developed and validated to both screen and triage women who may become or who are pregnant, including the CARPREG II (Cardiac Disease in Pregnancy Study), ZAHARA (Zwangerschap bij Aangeboren Hartafwijking), and modified WHO (World Health Organization) classification system. 8 These tools combine “lesion” or disease-specific information with patient-specific data to facilitate preconception counseling, prenatal management, preparation for delivery, referral to cardio-obstetric centers of excellence, and counseling related to pregnancy avoidance/contraception or, in circumstances where the life or long-term health of the mother is significantly at risk, termination of pregnancy. Risk assessment tools capture the presence and severity of underlying heart disease, hemodynamics, left ventricular function, arrhythmias, medications, and past pregnancy-related complications.…”