Outcome of cardiovascular surgery and pregnancy: A systematic review of the period 1984-1996

The outcomes of cardiovascular operations during pregnancy, at delivery, an d post partum were reviewed from published material in the period 1984-1996 . Surgery during pregnancy resulted in fetal-neonatal morbidity and mortali ty of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal out come. Maternal complications and mortality of surgery immediately after del ivery were 29% and 12%, respectively, and for surgery performed with a post partum interval the respective rates were 38% and 14%. Hospitalization afte r week 27 of gestation and extreme emergency contributed significantly to p oor maternal outcome. Maternal deaths were reported in 9% of valvular proce dures and in 22% of aortic or arterial dissection repairs and pulmonary emb olectomies. Fetal-neonatal risks of maternal surgery during pregnancy are h igh and unpredictable. Maternal risks of cardiovascular procedures during p regnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than tho se in nonpregnant cardiovascular surgical patients.