Challenges in management of pregnancy in Women with Congenital Heart Disease

Résumé

Introduction: Congenital heart disease (CHD) is a dynamic field with evolving evidence, particularly in the context of pregnancy in women. Presently, due to improved surgical and medical treatments, more individuals with CHD are reaching adulthood, including many women of childbearing age. However, they still face various cardiovascular risks. Aim of the study: This study aimed to evaluate the challenges of congenital heart disease in pregnant women. Methods and materials: This was an observational study that was conducted in Combined Military Hospital (CMH) Dhaka, Bangladesh from January 2020 to December 2021. In total 30 pregnant women with congenital heart disease were enrolled in this study as the study subjects. All the demographic, and clinical information were recorded. Baseline data, collected before or during the first prenatal visit, were retrospectively recorded from various medical records, including electronic and paper sources, as well as referrals from physicians. Results: Maternal cardiovascular risks were notable in unrepaired atrial septal defects (ASD), with arrhythmia (4.50%) and persistent NYHA deterioration (3.00%). Repaired ASDs had similar risks but a higher postpartum hemorrhage rate (16%). Repaired ventricular septal defects (VSD) carried a 2.30% maternal arrhythmia risk, while unrepaired VSDs had lower overall risks. Patent ductus arteriosus (PDA) showed a 1% maternal arrhythmia risk. Tetralogy of Fallot (TOF) had low maternal cardiovascular risks but increased obstetric complications. Conclusion: The study underscores the need for personalized and thorough management of pregnancies in women with congenital heart disease. This approach must take into account the unique characteristics and risks associated with both the mother and the fetus.