| Popis: |
Pregnancy in women with cyanotic congenital heart disease (CCHD) is considered to be at great maternal and fetal risk, but information on the impact and management of these pregnancies are sparse. Complications during pregnancy mainly depend on the underlying cardiac defect associated with the cyanosis. Heart failure is the most frequent and the most severe cardiac complication, specifically in patients with pulmonary arterial hypertension. Due to coagulation abnormalities associated with chronic cyanosis, bleeding as well as thrombosis may complicate the peripartum period and require specific attention. Fetal complications such as prematurity, low birth weight, abortion, and stillbirths are also very common and related to maternal cyanosis degree. Medication during pregnancy and post-delivery is a big concern, and adequate care during pregnancy, delivery, and the postpartum period requires a multidisciplinary team approach in tertiary center. Timely pre-pregnancy counseling should be offered to all women with CCHD to prevent avoidable pregnancy-related risks. This review summarizes physiologic modifications related to pregnancy in the setting of CCHD physiology, discusses potential maternal cardiovascular concerns and describes commonly encountered obstetrical and neonatal complications. Management issues are addressed, including counseling, anaesthetic considerations and the need for multidisciplinary specialized care. |
