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Risk of pregnancy in women with
    congenital heart disease

                         Ng Soo Khai
                       ...
   Number of women with congenital heart
    disease reaching childbearing age is
    growing owing to advances in medica...
CHD
Acyanotic
 ASD
 VSD
 PDA

Cyanotic
 Tetralogy of Fallot
 Tricuspid atresia
 Transposition of great vessel
 Pers...
Adaptations in pregnancy
 Imposes strain on heart and
  circulation leading to cardiorespiratory
  adaptations
 Rise in ...
 Hypercoagulable state – increase in
  Vit K dependent clotting factors and
  reduction in protein S
 Increased in throm...
Risks to mother
Cardiac complications
 Symptomatic arrhythmia
 Congestive heart failure
 Cardiovascular event
 Endocar...
 Arrhythmia - mostly supraventricular
  origin. Higher risk in
  TGA, AVSD, Fontan repair
 Heart failure - mostly in cya...
   Thromboembolic complications –
    substantially higher than normal
    population

A study of 688 pregnant women with...
Risks to fetus
 Spontaneous abortion
 Premature birth
 Intrauterine growth restriction (IUGR)
 Fetal & perinatal morta...
   Premature birth – rate of 16%, higher
    than generally population 10%

   Fetal and perinatal mortality - ~4% in
  ...
   Predictors for maternal and fetal
    complications :
-   Pulmonary hypertension
-   Maternal cyanosis
-   Preconcepti...
 New data shows no increase risk in
  maternal mortality in women with CHD
  uncomplicated by Eisenmenger’s
  syndrome.
...
Pulmonary Hypertension
 most serious risk especially Eisenmenger
  syndrome
Eisenmenger syndrome
 reversal of shunt in t...
 poorly tolerate the hemodynamic
  changes associated with pregnancy
  and susceptible to complications like
  preeclamps...
Cyanosis
   Arterial oxygen saturation before pregnancy –
    important predictor

Data from 104 pregnancies in 74 women ...
   Mother with cyanotic CHD without
    pulmonary hypertension, maternal risk
    is low but fetal risk is high.

96 preg...
   One recent study reported a 12%
    likelihood of a livebirth when the
    arterial oxygen saturation at rest was
    ...
 Review of most retrospective reports from
  1985-2006 that described the outcomes of
  2491 pregnancies in women with CH...
THE END
THANK YOU
15. Risk Of Pregnancy In Women With Congenital Heart
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15. Risk Of Pregnancy In Women With Congenital Heart

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Transcript of "15. Risk Of Pregnancy In Women With Congenital Heart"

  1. 1. Risk of pregnancy in women with congenital heart disease Ng Soo Khai Med IV
  2. 2.  Number of women with congenital heart disease reaching childbearing age is growing owing to advances in medical and surgical treatment  Despite these advances, congenital heart disease remains an important cause of maternal mortality and morbidity during pregnancy  2nd leading cause of maternal mortality (second to suicide)
  3. 3. CHD Acyanotic  ASD  VSD  PDA Cyanotic  Tetralogy of Fallot  Tricuspid atresia  Transposition of great vessel  Persistent truncus arteriosus  Others
  4. 4. Adaptations in pregnancy  Imposes strain on heart and circulation leading to cardiorespiratory adaptations  Rise in intravascular volume resulting in raise cardiac output by 50% during the 1st and 2nd trimester  Reduction in systemic vascular resistance with fall in blood pressure  Results in deterioration in women with CHD
  5. 5.  Hypercoagulable state – increase in Vit K dependent clotting factors and reduction in protein S  Increased in thromboembolic risk from uterus compression on IVC resulting in lower extremity venous stasis
  6. 6. Risks to mother Cardiac complications  Symptomatic arrhythmia  Congestive heart failure  Cardiovascular event  Endocarditis Obstetrical complications  Thromboembolic complications  Pre-eclampsia  Postpartum hemorrhage
  7. 7.  Arrhythmia - mostly supraventricular origin. Higher risk in TGA, AVSD, Fontan repair  Heart failure - mostly in cyanotic heart disease, Eisenmenger syndrome, and PAVSD  Cardiovascular events such as MI, stroke are seen mostly in those with Eisenmenger  Endocarditis – during labor and delivery. Simple ASD appear to be a greater risk.
  8. 8.  Thromboembolic complications – substantially higher than normal population A study of 688 pregnant women with CHD, incidence of thromboembolic events: - 2% in CHD compare to - 0.05-0.10% in normal pregnancy  Preeclampsia - cluster in patients with aortic coarctation, PS, PAVSD, and TGA.
  9. 9. Risks to fetus  Spontaneous abortion  Premature birth  Intrauterine growth restriction (IUGR)  Fetal & perinatal mortality  Congenital heart disease
  10. 10.  Premature birth – rate of 16%, higher than generally population 10%  Fetal and perinatal mortality - ~4% in CHD compare to <1% in normal. As high as 27% in Eisenmenger  Recurrence of CHD - risk is higher - 5.7% if mother had CHD - 2.2% if the father had CHD
  11. 11.  Predictors for maternal and fetal complications : - Pulmonary hypertension - Maternal cyanosis - Preconception history of adverse cardiac events eg MI, arrhythmia, TIA - Left heart obstruction (mitral valve area <2cm, aortic valve <1.5cm)
  12. 12.  New data shows no increase risk in maternal mortality in women with CHD uncomplicated by Eisenmenger’s syndrome.  Only mothers with Eisenmenger’s syndrome have substantial mortality during pregnancy of 10-30%
  13. 13. Pulmonary Hypertension  most serious risk especially Eisenmenger syndrome Eisenmenger syndrome  reversal of shunt in the setting of initial left-to- right shunt due to development of pulmonary hypertension  drop in systemic resistance that accompanied pregnancy amplify the shunt reversal  body cannot compensate such short term changes  severe and potentially fatal hypoxemia during pregnancy or postpartum period
  14. 14.  poorly tolerate the hemodynamic changes associated with pregnancy and susceptible to complications like preeclampsia and postpartum hemorrhage  50% - preterm delivery and fetal growth retardation  Only 15-25% progress to full term  Pregnancy is contraindicated in women with Eisenmenger syndrome
  15. 15. Cyanosis  Arterial oxygen saturation before pregnancy – important predictor Data from 104 pregnancies in 74 women with CHD: - 90% with cyanotic CHD - 19% with acyanotic CHD had significant postpartum complications  Arterial O2 saturation below 80% increases the risks  No evidence that high sat O2 administration benefits the mother
  16. 16.  Mother with cyanotic CHD without pulmonary hypertension, maternal risk is low but fetal risk is high. 96 pregnancies of cyanotic CHD:  43% live birth, 37% of which were premature  Mean weight of full term infants – 2.5kg compare to normal 3.5kg
  17. 17.  One recent study reported a 12% likelihood of a livebirth when the arterial oxygen saturation at rest was < 85%;  Livebirth rate improved to 63% when the oxygen saturation was > 85%.
  18. 18.  Review of most retrospective reports from 1985-2006 that described the outcomes of 2491 pregnancies in women with CHD: - Cardiac complications in 11% - 5% - heart failure - 4.5% - arrhythmias - 15% miscarriage - 5% chose to terminate pregnancy - 16% premature birth - 4% small for gestational age - 2.3% perinatal mortality - 1.7% fetal mortality
  19. 19. THE END THANK YOU
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