Abstract
ObjectiveTo inform on delivery outcomes achieved in congenital heart disease (CHD) patients by the Cuban National Programme for pregnancy and heart disease.MethodsSingle-centre retrospective study on a prospectively collected cardiac pregnancy database at a tertiary referral hospital (January 2000–May 2017). Primary outcomes: pregnancy duration, outcome, maternal/fetal complications.ResultsFour hundred sixty-seven pregnancies in 462 recorded cases reached third trimester. Median age: 25 (21–29) years. Patients presented in NYHA class I (97%, n = 453) or II (3%, n = 14), 6% (n = 27) had arrhythmias, 1% (n = 4) had co-morbidities, 1% (n = 4) had impaired left ventricular function. There were 464 singleton pregnancies and 3 twin pregnancies. Of the singleton pregnancies, one resulted in stillbirth (0.2%). The rest were live births (n = 463), median weight 3200 (2900–3421) grams. Median pregnancy duration: 39.1 (38.6–40) weeks. Caesarean rate: 34% (n = 156). All twin pregnancies (n = 3) resulted in live births (n = 6) via caesarean section, of median weight 2710 (2458–2850) grams and median pregnancy duration 37 (36–38) weeks. Maternal cardiovascular complications (< 0.5%, n = 2), and obstetric complications (14%, n = 67) did not result in any mortality. Small-for-gestational-age was the commonest neonatal complication (10%, n = 48), with zero mortality. Three neonates (1%) had CHD. Post-delivery maternal NYHA functional status: class I in 84% (n = 393), class II in 16% (n = 73), and class III in one patient (< 0.5%).ConclusionIn middle-income countries management of CHD pregnancies according to existing guidelines can achieve good maternal and fetal outcomes.
Highlights
Due to developments in cardiac surgery and congenital cardiology, women with congenital heart disease (CHD) are consistently reaching adulthood [1]
Complications in CHD pregnancies and risk assessment Complications arising from a CHD pregnancy can be broadly divided into three main categories: maternal cardiac complications, obstetric complications and fetal complications
Whilst overall rates of pregnancy-related hypertensive disorders are broadly similar to that of the healthy population (8.7% vs 8%), the incidence of pre-eclampsia and pregnancy induced hypertension can vary widely depending on the specific CHD examined
Summary
Due to developments in cardiac surgery and congenital cardiology, women with congenital heart disease (CHD) are consistently reaching adulthood [1]. CHD has since become one of the most common types of heart disease in pregnancy [2], and represents a significant cause of morbidity to the gravid patient, as well as a risk. In terms of obstetric complications, CHD pregnancies are associated with a higher rate of thromboembolism than in the general population (1:50 vs 1:1000-2000) [11]. Further complications include an increased risk of premature birth above background, growth restriction and stillbirth [4, 9, 15,16,17], perhaps going some way in explaining why fetal mortality rates are four times higher in CHD pregnancies [13]. Maternal mortality is not high for most types of CHD, rates of morbidity remain much higher in CHD patients and their offspring than in the general population [2]
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