P5473Pregnancy in women with complex congenital heart disease. A constant challenge. Data from InCor Registry

Abstract

Background: The improvement in surgical technique, intensive care and nonin-vasive diagnosis have contributed to higher survival rate and an increasing num-ber of childbearing women with complex congenital heart disease (CCC). How-ever, an adequate counseling and a safe management of pregnancy in women with CCC is uncertain, due to a wide spectrum of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyse hypoxemia as prognostic variable. Methods: From 2008 to 2016 we followed 405 consecutive pregnancies in pa-tients (pts) with congenital heart disease. Among of them we selected 45 preg-nancies in 42 women (mean age of 25.5±4.5 years) with CCC who had been discouraged to pregnancy. Women with Eisenmenger' syndrome were excluded. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries (16 pts.), pulmonary atresia (7 pts), tricuspid atresia (3 pts), single ven-tricle (4 pts), double-in-let right ventricle (5pts), double in-let left ventricle (5pts) and truncus arteriosus (2 pts). Ten 10 (25.5%) pts. had not prior surgery. Surgical procedures before gestation were: Fontan (8 pts), Jatene (7 pts) Rastelli (6 pts), Senning (3 pts) and others surgical techniques (8pts) including Blalock Tauss-ing, Glenn and Mustard procedures. Twenty-one (46.6%) pts had hypoxemia (rest oxygen saturation below 92%). During the first prenatal visit (mean of 12 weeks of gestation) the means values of oxygen saturation, hemoglobin and hematocrit were 92%, 14.8 mg/dl and 47%, respectively. Five (11.1%) pts had systemic ven-tricular dysfunction (EF% <50%). Routine prenatal care included: 1)obstetrical and cardiologist team follow-up weekly, 2) maternal and fetal echocardiography study, 3) adjusted of medications to pregnancy, 4) enoxaparin as anticoagulation, when necessary. Routine hospitalization was recommended from 32 weeks of gestation or face any complication. Results: Nineteen (45.2%) pts had maternal and fetal uneventful course. Seven (15.5%) pts had cardiac events as heart failure (4), hypoxemia (2), atrial flutter (1). Five (11.1%) pts had obstetrical complications: three placental pathologies (abruption, retention, accreta), one hemorrhage postpartum and one developed eclampsia. The latter two complications were causes of the two (4.1%) mater-nal death (4.4%), both of them with cyanotic lesions. There were 29 cesarean sections, 7 (15.5%) stillbirth, 16 (37.2%) premature babies. Stillbirth, prematurity and low birth weight were higher (p<0.05) in women with hypoxemia (33.3% vs 0%), (71.4% vs 20.8%) and (1877.8g ± 631.4 vs 2598.5g± 577.5), respectively. Congenital heart disease was identified in two (4.1%) infants. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hazards for maternal and fetal outcomes, especially in pres-ence of hypoxemia, discourage pregnancy to women with CCC even in expert center.