Abstract
The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. The objective of our study was to evaluate the impact of FCI on maternal condition, course of pregnancy, and delivery. 113 mothers underwent intrauterine treatment of their fetuses with critical heart defects. 128 percutaneous ultrasound-guided FCI were performed and analyzed. The patients were divided into four groups according to the type of FCI: balloon aortic valvuloplasty (fBAV), balloon pulmonary valvuloplasty (fBPV), interatrial stent placement (IAS), and balloon atrioseptoplasty (BAS). Various factors: maternal parameters, perioperative data, and pregnancy complications, were analyzed. There was only one major complication—procedure-related placental abruption (without need for blood products transfusion). There were no cases of: procedure-related preterm prelabor rupture of membranes (pPROM), chorioamnionitis, wound infection, and anesthesia associated complications. Tocolysis was only necessary only in two cases, and it was effective in both. None of the patients required intensive care unit admission. The procedure was effective in treating polyhydramnios associated with fetal heart failure in six out of nine cases. Deliveries occurred at term in 89%, 54% were vaginal. The results showed that FCI had a negligible impact on a further course of pregnancy and delivery.
Highlights
The aim of fetal cardiac interventions is to change the natural course of some critical congenital heart defects [1,2,3,4,5] and, to save fetal or neonatal life
In order to improve fetal cardiac function, we introduced transplacental treatment with digoxin, using its positive inotropic effect
The majority of fetal cardiac interventions (FCI) worldwide used to be performed under maternal general anesthesia with intubation, according to the published data [3,4,5,29,30]
Summary
In the cases of left heart disease with closed foramen ovale, the aim of the intervention is to prevent the damage of pulmonary vessels that would inevitably lead to life-threatening pulmonary hypertension and often irreversible anatomical changes in pulmonary circulation [5,9,10,11,12]. In such cases, FCI aims to improve the maternal condition, as these defects commonly cause severe polyhydramnios, which may significantly affect maternal health and the course of pregnancy
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