Obstetric and perinatal aspects in patients with congenital heart diseases
Keywords:
Pregnancy, Congenital heart disease, newbornAbstract
The benefits of surgical treatment for patients with congenital heart disease in relation to pregnancy are still controversial. We studied 48 pregnant women (mean age = 25 years) with surgically-corrected congenital heart diseases (Group 1). This included 15 cyanotic diseases: Fallot's tetralogy (11 cases); Ebstein's anomaly (2 cases); transposition of the great arteries (1 case); and double outlet of the right ventricle (1 case). We compared them to 52 pregnant women (mean age = 26 years) with untreated congenital heart diseases, which included 11 cases of Eisenmenger's syndrome (Group 2). Group 2 showed a higher incidence of maternal death (12 vs. 0 percent; p=0.01), perinatal mortality (15 vs. 0 percent; p=0.01) and prematurity (32 vs. 7 percent; p=0.01). Spontaneous abortion (4 vs. 10 percent), Caesarean deliveries (48 vs. 66 percent) or growth retardation (13 vs. 28 percent) did not present any significant differences between these groups. Surgical treatment in patients with heart diseases is associated with a better maternal and fetal prognosis. Therefore, surgery must be considered when counseling patients with congenital heart diseases.
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References
Ueland K. Cardiovascular diseases complicating pregnancy. Clin Obstet Gynecol 1978;21:429.
Perloff JK. Pregnancy and cardiovascular disease. In: Braunwald E, ed. Heart disease. Philadephia: Saunders, 1983:1763-81.
Sugrue D, Blake S, MacDonald D. Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland, 1969 to 1978. Am J Obstet Gynecol, 1981;139:1.
Schaefer G, Arditi LL, Solomon HA, Ringland JE. Congenital heart disease and pregnancy. Clin Obstet Gynecol 1968;1:1048.
Pontes MD. Abortamento. In: Neme B, ed. Patologia da gestação. São Paulo: Sarvier, 1988:1.
Rezende J, Montenegro CAB, Barcelos JM. Abortamento. In: Obstetrician, 4th ed. Rio de Janeiro: Guanabara Koogan, 1982:563.
Macnulty JH, Metcalfe J, Ueland K. Doença cardiovascular. In: Burrow and Ferris, eds. Complicações clínicas da gravidez, 2nd ed. São Paulo: Roca, 1983:143.
Niswonger JWH, Langmade CF. Cardiovascular changes in vaginal deliveries and Caesarean sections. Amer J Obstet Gynec 1970;107:337.
Barnes CG. Heart disease in pregnancy. In: Medical Disorders in Obstetric Practice, 4th ed. Oxford and Edinburgh: Blackwell, 1970.
Metcalfe J, Mcanulty JH, Ueland K. eds. Burwell and Metcalfe's heart disease and pregnancy. Boston: Little, Brown & Co, 1986:223-64.
Goodwin JF. Pregnancy and coarctation of the aorta. Clin Obstet Gynecol 1961;4:645.
Mendelson CL. Pregnancy and coarctation of the aorta. Am J Obstet Gynecol 1940;39:1014.
Hoffmann JL, Christianson R. Congenital heart disease in a cohort of 19,502 births with long term follow-up. Am J Cardiol 1978;42:641.
Whittemore R, Hobbins JC, Engle MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 1982;50:641-51.
Czeizel A, Pornoi A, Peterffy E. Study of children of parents operated on for congenital cardiovascular malformations. Br Heart J 1982;47:290.
Nora JJ, Nora AH. The evolution of specific genetic and environmental counseling in congenital heart disease. Circulation 1978;57:212.