Abstract 15303: Maternal Features for Live Births in Fontan Patients

Abstract

Introduction: As the population of women with congenital heart disease with prior Fontan palliation (PFPs) increases, doubling in size over the next 20 years, there will be a concordant need for multidisciplinary obstetrics care. There is an increased prevalence of miscarriage, maternal and fetal complications including arrhythmias, heart failure, premature birth, and neonatal death. We sought to review our single center experience in the context of an established cardio-obstetrics multidisciplinary team. Methods: Single-center retrospective cohort study of PFPs with live births who received care at our cardio-obstetrics clinic. A chart review was performed to identify maternal characteristics as well as fetal outcomes. Descriptive statistics were calculated using R Studio Statistical Software version 1.2.5033.Result: Ten women with PFPs and live births were identified. None had more than one live pregnancy. The average number of pregnancies was 2 (range 1-6). The mean gestational age was 31.2 weeks (range 23-37). Five patients were primigravida. Six of the pregnancies were planned and eight received preconception counseling. Baseline NYHA was 50% class I and 50% class II. The most common maternal comorbidity in patients with a live pregnancy was atrial arrhythmia, and the most common pre-pregnancy medication was warfarin. Prematurity, low birth weight, and associated comorbidities (see table 1) were common in this population. The average birthweight was 1,589g (range 460g-2210g). Indication for delivery was more commonly obstetric than maternal concern. No maternal strokes, thromboembolic events, cardiac arrests, maternal or infant deaths and rehospitalizations were noted. Conclusion: Maternal and fetal complications in mothers with PFP are common. A multidisciplinary approach in a specialized cardio-obstetrics clinic has the potential to improve outcomes. Larger cohort and long term outcomes are needed in this patient population.