[Pregnancy and tetralogy of Fallot with and without surgical correction]. / Embarazo y tetralogía de Fallot con y sin corrección quirúrgica.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital cardiac lesions. Although pregnancy in patients with corrected tetralogy of Fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications. OBJECTIVE: To report our experience in monitoring and treatment of 16 pregnancies in 14 women with tetralogy of Fallot. PATIENTS AND METHOD: Prospective study performed in 16 pregnancies of 14 patients with tetralogy of Fallot, who attended the services of Cardiology and High Risk Pregnancy in the Hospital de Gineco-Obstetricia of the Centro Médico de Occidente (Mexico), from January 1997 to January 2010. Nine women had total surgical correction and five hadn't. All patients obtained complete study protocol and tests of fetal wellbeing. RESULTS: Hemoglobin and hematocrit were significantly higher in the group without surgical correction; this group also had lower oxygen saturation and right ventricular enlargement. Of the 16 pregnancies, five were resolved vaginally, the other by cesarean section. The cyanotic mothers had premature termination of pregnancy, lower birth weight and Apgar slightly deteriorated. There were no maternal or neonatal deaths, neither cardiac malformation in newborns. CONCLUSIONS: There are more risks for the binomial in patients with uncorrected tetralogy of Fallot and in those operated with significant residual lesions. A greater anatomical impact was significantly correlated with major hemoglobin and minor oxygen saturation, which are the most important risk factors for adverse fetal outcomes.

[Chronic high blood pressure in 110 pregnant women]. / Hipertensión arterial crónica en 110 mujeres embarazadas.

BACKGROUND: Hypertension is associated with increased maternal and fetal mortality and morbidity. While there is consensus that severe hypertension should be treated, antihypertensive treatment for mild chronic hypertension during pregnancy remains controversial. OBJECTIVE: To evaluate clinical course, and maternal and perinatal outcomes of pregnant women with mild chronic hypertension without other disease, under strict control of maternal hypertension (target dBP of 85-89 mmHg). PATIENTS AND METHODS: We conducted a prospective cohort study of 110 pregnant women with mild chronic hypertension without other disease; clinical course was classified in three groups: stable condition, exacerbation of hypertension and superimposed preeclampsia. We compare maternal and perinatal outcomes; statistical comparisons were performed by ANOVA test. Relative risk (RR) was calculated for adverse perinatal outcomes. RESULTS: Atotal of 110 women were included, mean maternal age was 33 +/- 5.8 years. There were 78 (71%) women with stable condition, 26 (24%) with exacerbation of hypertension and 6 (5%) with superimposed preeclampsia (PE). Women with superimposed PE and exacerbation of hypertension delivered earlier and had more small for gestational age (SGA) babies than women with stable condition and exacerbation. Delivery route was vaginal in 45 patients (40%) while 65 patients (60%) underwent cesarean section in order to avoid fetal distress. CONCLUSIONS: Results demonstrated that fetuses in the stable condition group (strict control) did not have worst outcomes than those in the other groups. This cohort study shows efficacy and safety of treating mild chronic hypertension during pregnancy.

[Pregnancy in patients with single ventricle, corrected and uncorrected]. / Embarazo en pacientes con ventrículo único, con y sin corrección quirúrgica.

We describe two cases of pregnancy in women with congenital heart disease, single ventricle. The first one underwent Fontan surgery at the age of 5 years due to a single ventricle of the left ventricular morphology. The second one, had uncorrected single ventricle. There were no maternal complications. Both deliveries were by cesarean section. Infants were premature, being delivered at 33 and 27 weeks, and weighing 1,250 and 625 g, respectively.