1 / 12

The 3rd International Congress on Cardiac Problems in Pregnancy – Venice 2014

varick
Download Presentation

The 3rd International Congress on Cardiac Problems in Pregnancy – Venice 2014

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Outcomes of pregnancy in women after Fontan palliationMarielle Gouton, MagalieLadouceur, Jacky Nizard, Marc DommerguesCentre Chirurgical Marie Lannelongue – Le Plessis-RobinsonHôpitalEuropéen Georges Pompidou – Paris GroupementHospitalier La Pitié-Salpêtrière – ParisFrance The 3rd International Congress on CardiacProblems in Pregnancy – Venice 2014

  2. Design • Outcomes of all pregnancies in women with Fontan palliation in France • Methods : • Retrospective study • French M3C centers • 2001-2013 • All known pregnancies • Cardiac, obstetrical and neonatal complications • Pre-partum, peri-partum, post-partum, follow-up Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  3. Population • 27 women, 41 pregnancies (1 twin-pregnancy) • 4 / 27 (15 %) had previous infertility • 9 had 2 pregnancies or more • Age at first pregnancy : 20 – 41 y (mean 27± 5) Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  4. Population Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  5. Results : 41 pregnancies 58 % 33 % Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  6. Maternal complications10 / 41 (25 %) Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  7. Obstetrical complications 25 / 41 (61 %) Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  8. Anticoagulation ? Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  9. Post-natal follow-up • Mode of delivery : • Vaginal : 12 • Cesarean section : 12 • Mean gestational age : 34 (±3) w • Mean birth weight : • 2024 (±690) g (10th percentile) • Prematurity : 17 / 24 (70 %) • 33-36+6 w : 11 • 28-32+6 w : 5 • 22-27+6 w : 1 • Neonatal death : 1 (birth at 25 w) • Twins : birth by cesarean section at 32 w • Recurrence of congenital heart disease : • 1 left superior vena cava • (fetal death : tricuspid atresia) Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  10. Maternalfollow-up • Post-partum complications • Parietal hematoma :1 • Fontan failure: 1 • ↗NYHA: 1 • 21 / 27 women (75%) have ≥ 1 newborn • 0 newborn : 6 • 1 newborn : 18 (1 neonatal death) • 2 newborns : 3 • Late follow-up : 43 months (1 – 144) • Fontan failure : 2 • No maternaldeath Le switch a 30 ans ! Atelier-débat - CCML 6 et 7 février 2014

  11. Fontan and pregnancy: Is it possible ? • Yes, but only if : • Pre-conception visit • Cardiac function • Ventricular function (echo, MRI) • TCPC function • AV valve insufficiency • Counseling • High risk of maternal complications • Arrhythmia • Thromboembolism • Therefore: anticoagulation • High risk of miscarriage (33%) • High risk of prematurity (70%) • Risk of recurrence • Multidisciplinary follow-up (tertiary hospital) • Adult cardiac congenitalist • Obstetrician • Anesthesiologist • Neonatologist • Vaginal delivery if obstetrician agrees Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  12. Fontan and twin pregnancy ?Yes, they can Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

More Related