Abstract
Background
Parturients with congenital heart disease are at increased risk of maternal cardiac
and neonatal complications. There is a paucity of literature regarding the relationship
of complications with the type of anesthesia or mode of delivery.
Methods
We retrospectively reviewed all parturients with congenital heart disease undergoing
delivery over a 7-year period at Tokyo Women’s Medical University, Maternal and Perinatal
Center to identify maternal cardiac and neonatal complications occurring during the
peripartum period.
Results
Of 151 pregnancies in 128 women with congenital heart disease, there were 84 vaginal
and 67 cesarean deliveries. Cesarean deliveries were performed with either neuraxial
(n = 51) or general (n = 16) anesthesia. There were no maternal deaths and two neonatal deaths (one vaginal;
one cesarean delivery). The incidence of maternal cardiac events was 1 in 84 (1%)
for vaginal deliveries and 10 in 67 (15%) for cesarean deliveries. Neonatal complications
occurred in 11 of 84 (13%) pregnancies with vaginal delivery and 25 of 67 (37%) pregnancies
with cesarean delivery. Twenty-three elective cesarean deliveries occurred for maternal
cardiac problems and were associated with a significant incidence of maternal cardiac
(35%) and neonatal (65%) complications. The incidence of maternal cardiac events during
delivery, when stratified by severity of cardiac disease, was similar to a previously
derived cardiac risk index for pregnant women with cardiac disease.
Conclusion
Despite a low overall incidence of maternal and neonatal mortality, pregnancy in women
with congenital heart disease was associated with significant maternal cardiac and
neonatal complications. Elective cesarean delivery with neuraxial anesthesia was a
common approach for high-risk parturients with congenital heart disease; however,
the benefit of this mode of delivery and anesthetic technique could not be ascertained.
Keywords
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Article info
Publication history
Published online: June 06, 2011
Accepted:
March 18,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
