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Pregnancy risky after heart defect repair
Published in Saudi Press Agency on 04 - 09 - 2006


New data suggests that women
who have undergone a successful surgery to repair congenital
heart defects can become pregnant, but they may have clinically
significant complications, according to Reuters.
Until recently, pregnancy was discouraged in women who have
undergone the so-called "Fontan operation" to correct complex
birth defects of the heart. However, case reports and one
clinical study suggest that women can become pregnant and
deliver healthy infants.
To investigate further, Dr. Willem Drenthen, a cardiologist
at the University of Groningen, and his team identified 38
women ages 21 to 58 who had undergone the heart surgery for
various congenital heart defects.
Between 1986 and 2003, seven women tried to conceive, and
six became pregnant a total of 10 times, which resulted in four
live births. There were two premature deliveries, and two
infants were small for gestational age.
All four births were accompanied by significant
complications, including deterioration in heart function, a
dangerous heart arrhythmia called atrial fibrillation,
pregnancy-related high blood pressure, premature membrane
rupture, premature birth, fetal growth retardation and neonatal
deaths. However, the mothers' complications resolved fairly
quickly afterwards.
Overall, infertility appears to be frequent in these women;
many of the women stopped menstruating, the investigators
learned.
The authors reviewed the literature for studies regarding
pregnancy after the Fontan operation, which is named after the
developer of the procedure. Overall, obstetric complications
were common, they report, with 15 of 39 completed pregnancies
ending with premature birth.
Drenthen's group concludes that the pregnancy is not likely
to cause severe complications among women whose Fontan
palliation resulted in adequate repair.
However, based on the high miscarriage rates, other
complications during pregnancy, neonatal deaths, and lack of
data regarding long-term outcomes, they write, "these problems
are important reasons to regard pregnancy as not advisable."


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