title: Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot.
abstract: OBJECTIVE
  Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF.
  
  
  METHODS
  We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation.
  
  
  RESULTS
  We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.
authors.forename: M A M
authors.initials: MA
authors.lastname: Kampman
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: A S
authors.initials: AS
authors.lastname: Siegmund
authors.affiliation: Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Bilardo
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Balci
authors.affiliation: Department of Obstetrics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: B J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Sieswerda
authors.affiliation: Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M W M
authors.initials: MW
authors.lastname: de Laat
authors.affiliation: Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Sollie-Szarynska
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010920:Placenta / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: congenital heart disease; pregnancy outcome; uteroplacental Doppler flow