Obstetric and perinatal aspects in patients with congenital heart diseases.

ABSTRACT

PIP: In a prospective study of 100 pregnant Brazilian women with congenital heart diseases, the 48 patients who had undergone corrective surgery an average of 10 years before the index pregnancy (group 1) had substantially better maternal and fetal/neonatal outcomes than the 52 women with no history of surgery (group 2). Group 1 included 16 women with cyanotic diseases and 9 with residual heart lesions. In Group 2, 11 women had Eisenmenger's syndrome. There were 6 maternal deaths (12%) in Group 2: 3 related to Eisenmenger's syndrome and 3 in women with aortic or subaortic stenosis, but none in Group 1. There were 2 fetal and 5 neonatal deaths in Group 2, but, again, no such deaths in Group 1. Most maternal and fetal/neonatal deaths were associated with left obstructive involvement and cyanosis. Group 2 also included significantly more cases than Group 1 of low birth weight (38% versus 13%), premature birth (32% versus 7%), and intrauterine growth retardation (28% versus 13%). The highest rates of these adverse outcomes were recorded among infants of mothers with Eisenmenger's syndrome, obstructive involvement, and cyanosis. Residual surgical lesions had no adverse effects on maternal or infant outcomes. Surgery should be considered in patients with correctable heart disease who desire pregnancy. However, pregnancy is not recommended for women with Eisenmenger's syndrome and aortic stenosis.