Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot

Abstract

The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot

“…These findings suggest that impaired RV function might be a predisposing factor for poor placental function, which is known to be associated with adverse maternal and neonatal outcome. The current study combining CMR with PI confirms our previous findings that pre-existing reduced RV function is associated with impaired uteroplacental circulation [1,[12][13][14]. In our previous echocardiographic studies, we were limited in the assessment of RV function and CO measurements due to the specific modality.…”

“…In the ZAHARA II and III study 66 repaired ToF women were included. For the present study, women were excluded because of miscarriage (n = 3), no CMR evaluation available because of a pacemaker (n = 3) or no CMR evaluation available within 2 years before pregnancy (n = 29), resulting in a total study population of 31 repaired ToF women (median time between the CMR evaluation and date of conception was 8 [3][4][5][6][7][8][9][10][11][12][13][14] months).…”

“…Median time between pre-pregnancy CMR evaluation and uteroplacental flow measurements at 20 weeks and 32 weeks gestation were 12 [7][8][9][10][11][12][13][14][15][16][17][18][19] Tables 3 and 4. Reduced RVEF, higher indexed LV end diastolic volume (EDV) and LV end systolic volume (ESV) were associated with impaired uterine artery PI at 20 weeks with univariable analyses (P = 0.037, P = 0.001 and P = 0.003, respectively).…”

Pregnancy outcomes among 31 patients with tetralogy of Fallot

“…However, we occasionally encountered that women with uncorrected TOF got pregnant. Due to the extra cardiac load during pregnancy, women with uncorrected TOF had much higher maternal and perinatal morbidity compared to general population [1][2][3][4][5]9]. These cases are relatively rare and almost all of published studies for these patients in the literature were case reports.…”

Pregnancy outcomes among 31 patients with tetralogy of Fallot

“…But it is generally known that heart disease constitutes a leading nonobstetric cause of maternal mortality especially in patients with those cyanotic and complex shunt lesions [4]. Previous studies on pregnant women with TOF showed that pregnancy carries a considerable risk to the women's status, and the adverse cardiovascular events may be associated with right ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction [10,11]. Right ventricular function parameters with abnormal uteroplacental Doppler flow (UDF) suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications [11].…”