Successful pregnancy in a patient with univentricular heart and pulmonary stenosis

Pregnancy outcome in women with an uncorrected single ventricle: A single-centre experience from South India

Background

Women with an uncorrected single ventricle heart are at increased risk of adverse maternal and perinatal outcomes.

Methods

We report our experience of managing pregnant women with uncorrected single ventricles, during the time period 2011 to 2017, in a low-resource setting and compare pregnancy outcome with healthy concurrent controls. Outcomes assessed include the mode of delivery, maternal complications, neonatal death and birth weight.

Results

There were six pregnant women with uncorrected single ventricles who had a total of 14 pregnancies. There was one maternal death in a woman with atrioventricular-septal defect and Eisenmenger syndrome. Caesarean section rates and preterm delivery were similar, whereas perinatal loss and low-birth weight rates were higher among women with a single ventricle compared to healthy controls.

Conclusion

Unplanned pregnancies without prenatal counselling/care pose a challenge to physicians especially in low to middle income countries and with the high risk of morbidity/mortality, pregnancy should be discouraged.

A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease

Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age, miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary vascular resistance, ensuring minimal change in right-to-left shunting. We report a case of a successfully managed pregnancy in a patient with complex congenital heart disease and a single ventricle of left ventricle morphology.

Complex congenital heart disease in a complicated and precious pregnancy

A single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. A woman was assessed in our obstetric clinic for the first time at the gestational age of 28 weeks and found to have placental bleeding. She also had complex congenital heart disease and atrial fibrillation requiring anticoagulation. Echocardiography revealed double-inlet single ventricle with right and left atrioventricular valves entering into this chamber and levo-transposition of the great arteries. After an extensive discussion with the patient regarding the risks and benefits of anticoagulation including risk of stroke, the agreed plan was to start her on intravenous heparin with close observation and to continue pregnancy for at least 32 weeks in order to reduce the postpartum risk for the fetus. The pregnancy progressed without any further complications and the patient had elective caesarean section at 33 weeks of gestation and delivered a healthy baby boy.

Successful pregnancy and delivery in patients with uncorrected single ventricle: Three new cases and literature review

Due to high risks of both maternal and fetal complications, pregnancy is not encouraged for women with uncorrected univentricular heart (UVH). Here, we report three cases of successful pregnancy and delivery in patients with uncorrected UVH. A literature review has been performed. It appears that maternal and neonatal risks are mainly associated with higher NYHA heart failure class, pulmonary hypertension, and history of congestive heart failure. In the absence of these risk factors, successful pregnancy still can be achieved with mild complications. Care by a multidisciplinary team during delivery is necessary to for a good prognosis.