Women With Complex Congenital Heart Disease can Have Successful Pregnancies

Women With Complex Congenital Heart Disease can Have Successful Pregnancies

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Highlights
  • Congenital heart diseases are serious abnormalities in the structure and function of the heart that are present at birth.
  • The American Heart Association has issued new recommendations to provide guidance for managing successful pregnancies in women with heart defects.
  • Women with congenital heart defect can have successful pregnancies with proper management in the hands of experienced cardiologists and obstetricians.
The American Heart Association has issued new recommendations to provide guidance about managing successful pregnancies, childbirth and post-natal care to women with complex congenital heart defects and their healthcare providers.
Women With Complex Congenital Heart Disease can Have Successful Pregnancies

"Women with complex congenital heart disease were previously advised to not get pregnant because of the risk to their life," said Mary M. Canobbio, R.N., M.N., chair of the writing committee and a lecturer at UCLA School of Nursing in Los Angeles, California.

But now a scientific research demonstrates that women with congenital heart defects can have successful pregnancies with proper management in the hands of experienced cardiologists and obstetricians.

Congenital Heart Disease

Congenital heart defects are serious abnormalities of the heart. They are also referred to as congenital heart diseases, cyanotic heart disease, heart defects and congenital cardiovascular malformations.The abnormalities can be in the structure or the function of the heart which is present at birth.

The most common form of birth defects is heart defects. In America, more than 32,000 infants are born each year with some form of heart defect. This means 1 out of every 125 to 150 infants are born with a heart condition.

People born with these conditions need immediate medical care soon after birth and the care needs to continue throughout their lives.

In just 22 days after conception, a baby's heart begin to develop and starts beating.

Between days 22 and 24, the heart begins to bend to the right and fold itself into a loop. By day 28, the tube has a general heart-shaped form with the structures of the chambers and blood vessels in place.

Structural defects mainly occur during this time of development.

Congenital heart defects can:
  • Disrupt the normal flow of blood through the heart
  • Slow down blood flow
  • Cause blood to flow in the wrong direction or go to the wrong place
  • Block the flow completely
Risk Factors for the Fetus

Babies of pregnant women with congenital heart disease also face some risks. The risks are:
  • Small for gestational age babies
  • Premature birth
  • Small chance of inheriting the heart defect
Heart

The human heart has four chambers. The upper chambers are called the atria and the lower chambers are the ventricles. The atria receive the blood into the heart while the ventricles pump the blood out of the heart.

Some of the complex congenital heart defects include:

Single ventricle- In this condition, the patient is born with only one ventricle. Therefore there is only one functioning ventricle to pump blood. Symptoms of this condition include blue or purple tint to lips, skin and nails, difficulty breathing, difficulty feeding and lethargy.

Transposition of the great arteries- In this condition, the position of the two main arteries leaving the heart are reversed. The two main arteries are pulmonary artery and aorta. The pulmonary artery carries impure blood from right ventricle to the lungs and the aorta carries oxygenated blood from the left ventricle to the rest of the body. This condition decreases the amount of blood passing through the lungs.

Severe aortic stenosis- In this condition, the aortic valve that separates the left ventricle and the aorta did not form properly and is critically narrowed, making it difficult for the heart to pump blood to the body. This condition decreases the amount of blood traveling to the body.

Pulmonary hypertension (PH)- It is a type of high blood pressure that affects the arteries in the lungs.

It is a serious condition that has no cure. It causes stiffening and narrowing of the blood vessels that carry blood from heart to lungs. As a result, the heart needs to work harder to pump the blood through. Over time, the heart weakens and may eventually fail.

Symptoms of PH include shortness of breath during routine activity, such as climbing two flights of stairs, fatigue, pain in the chest and upper right side of the abdomen, increased heart rate and poor appetite. Treatments may help to control symptoms.

Eisenmenger syndrome- A heart condition that causes a hole (shunt) to develop between two chambers of the heart. This hole causes blood to circulate abnormally in your heart and lungs.

More blood is pumped into the lungs and the blood vessels in the lung arteries become stiff and narrow. This increases the pressure in the lungs' arteries leading to pulmonary hypertension. This causes permanent damage to the blood vessels of the lungs.

Blood deprived oxygen from the right side of the heart flows into the left ventricle and is pumped to the body. So all the organs are deprived of oxygen.

Eisenmenger syndrome is a life-threatening condition requiring careful medical monitoring.

Most women with congenital heart conditions do well and get to the child-bearing age.

What Needs to Be Done

Pregnancy in women with complex congenital heart disease carries a moderate to high-risk for both the mother and her child.

Before getting pregnant, women with complex congenital heart defect should have a pre-pregnancy counseling so that they have a clear understanding of how their heart abnormalities could affect both their health and the health of their child during pregnancy.

Once pregnant, a delivery plan is also essential to be prepared for the problems that could happen during and following delivery and be prepared.

The authors recommend pregnant women to deliver their babies at medical centers that have a cardiologist who is experienced in managing complex congenital heart disease, obstetricians trained in high-risk maternal-fetal medicine, cardiac anesthesia, and a cardiac surgical team.

After delivery, the postpartum period lasts for six weeks, but the effects of pregnancy can linger with the woman for six weeks and as long as six months. Therefore careful monitoring of the mother is necessary and needs to continued.

"This scientific statement outlines the specific management for these high-risk patients," Canobbio said.

"What we know about the risks for these patients, what the potential complications are, what cardiologists, advanced practice nurses and other cardiac health providers should discuss in counseling these women, and once pregnant, recommendations in terms of the things we should be looking out for when caring these women," Canobbio adds.

References:
  1. Mary M. Canobbio et al. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation ; (2017) doi.org/10.1161/CIR.0000000000000458
  2. Congenital Heart Defects - (http://americanpregnancy.org/birth-defects/congenital-heart/)
  3. Single Ventricle Heart Defects - (http://www.chop.edu/conditions-diseases/single-ventricle-heart-defects)
  4. Congenital Heart Disease - (http://www.chop.edu/conditions-diseases/congenital-heart-disease)
  5. Eisenmenger syndrome - (http://www.mayoclinic.org/diseases-conditions/eisenmenger-syndrome/home/ovc-20177618)
  6. Pulmonary Hypertension - (https:medlineplus.gov/pulmonaryhypertension.html)
Source: Medindia

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