Outcome of pregnancy in women with congenital heart disease

Improvements in diagnosis and surgical technique for correction have led to an increasing number of women with congenital heart disease reaching the c hild-bearing age. Pregnancy places considerable strain on the heart and cir culation and necessitates marked cardiorespiratory adaptation. Today, with the exception of the Eisenmenger syndrome, there is no increased mortality associated with pregnancy in congenital heart disease. In contrast, there i s still considerable morbidity, due to congestive heart failure, thromboemb olic complications and disturbances of rhythm. Fetal outcome is complicated by a high rate of spontaneous abortions (20-25 %), retardation of fetal growth, and premature delivery (almost 100% in cya notic mothers), Based on an extensive review of the literature, we discuss the specific risks in pregnancy depending on the hemodynamic situations pro duced by different heart defects. We also discuss the risks and advantages of different regimens for anticoagulation. Counselling concerning contraception is frequently inadequate. The most imp ortant problems are thromboembolic complications with the use of hormonal c ontraception, and hyper- and dysmenorrhea in those using intrauterine devic es. Finally, the genetic risks must be considered, differentiating between single gene defects and the sex of the parents suffering from congenital he art diseases.