Pregnancy in congenital cardiac disease: an increasing challenge for cardiologists and obstetricians -- a prospective multicenter study.
OBJECTIVE
Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed.


RESULTS
Initially all women were in Functional Class I or II. Worsening during pregnancy occurred in 25.5% (n=27), mainly during the second and third trimester. Significant problems due to bleeding, hypertension, rhythm disturbances, endocarditis, liver congestion, increasing cyanosis or death, occurred in 11.3%. Twelve per cent of deliveries were premature. Five women had therapeutic abortion, nine spontaneous abortions, nine preterm births, and one intrauterine death. Seventy-nine per cent (n=85) delivered spontaneously; 21.3% (n=23) had caesarean section. Of the 111 live born children, 5.4% (n=6) had a CCD.


CONCLUSIONS
Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.
Kaemmerer
H
H
Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 München, Germany. Kaemmerer@dhm.mhn.de
Bauer
U
U
Stein
J-I
JI
Lemp
S
S
Bartmus
D
D
Hoffmann
A
A
Niesert
S
S
Osmers
R
R
Fratz
S
S
Rossa
S
S
Lange
P E
PE
Beitzke
A
A
Schneider
K T M
KT
Hess
J
J
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002585:Cesarean Section; D003131:Combined Modality Therapy; D005113:Extraction, Obstetrical; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005858:Germany; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening; D007744:Obstetric Labor Complications / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000628:therapy*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis