Obstetric and gynecologic complications in women with Marfan syndrome.
OBJECTIVE
To analyze the maternal and fetal outcomes of pregnancy and gynecologic problems in women with Marfan syndrome.


METHODS
The outcomes of 14 pregnancies in 4 women with Marfan syndrome were prospectively observed between January 1988 and December 2000. The cardiovascular and obstetric complications were analyzed. During pregnancy all the patients were carefully monitored with serial echocardiography and close attention to symptoms.


RESULTS
Of the 14 pregnancies, 5 (35.7%) ended in abortion, and 3 of them occurred in the early second trimester due to cervical incompetence. Premature onset of labor occurred in 2 pregnancies at 31 and 34 weeks. Postpartum hemorrhage complicated 3 deliveries, and inversion of the uterus occurred in 1 patient. Significant cardiovascular complications occurred in 2 patients, who required surgical correction of the aortic aneurysm and replacement of the aortic valve. In one patient the operation was performed within hours of vaginal delivery, and the other patient underwent surgery 8 weeks postpartum. No maternal death occurred in the study. One infant in the series was diagnosed as having Marfan syndrome. A premature infant delivered at 31 weeks died on the second day of life.


CONCLUSIONS
Women with Marfan syndrome are at high risk of aortic dissection in pregnancy even in the absence of preconceptional aortic root dilatation. Obstetric complications in patients with this condition have been underreported in the past. Women with aortic root dilatation of < 40 mm usually tolerate pregnancy well, with good maternal and fetal outcomes. Women with Marfan syndrome should be counseled regarding the risk of pregnancy to both mother and fetus. Patients who have cardiac decompensation or aortic dilatation > 40 mm are advised to avoid pregnancy.
Rahman
Jessica
J
Department of Obstetrics and Gynecology, College of Medicine, King Faisal University, Dammam, Saudi Arabia.
Rahman
Farooq Z
FZ
Rahman
Waheeda
W
al-Suleiman
Suleiman A
SA
Rahman
Mohammad Sayedur
MS
D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications*; D007752:Obstetric Labor, Premature / Q000150:complications; D006473:Postpartum Hemorrhage / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000150:complications