Pregnancy and delivery in women after Fontan palliation

Objectives: To evaluate the outcome of pregnancy in women after Fontan palliation and to assess the occurrence of infertility and menstrual cycle disorders. Design and patients: Two congenital heart disease registries were used to investigate 38 female patients who had undergone Fontan palliation (a...

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Bibliographic Details
Published in:Heart (British Cardiac Society) 2006-09, Vol.92 (9), p.1290-1294
Main Authors: Drenthen, W, Pieper, P G, Roos-Hesselink, J W, van Lottum, W A, Voors, A A, Mulder, B J M, van Dijk, A P J, Vliegen, H W, Sollie, K M, Moons, P, Ebels, T, van Veldhuisen, D J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Biological and medical sciences
caesarean section
Cardiology. Vascular system
Cardiovascular disease
Childbirth & labor
CONCOR
CONgenital CORvitia
Congenital diseases
Congenital Heart Disease
Delivery. Postpartum. Lactation
Family medical history
Female
Fertility
Fontan Procedure
Gynecology. Andrology. Obstetrics
Heart Defects, Congenital - complications
Heart Defects, Congenital - surgery
Humans
Hypertension
Infertility
Infertility, Female - etiology
Medical records
Medical sciences
Menstruation
Menstruation Disturbances - etiology
Middle Aged
Miscarriage
New York Heart Association
NYHA
Obstetrics
Palliative Care
Population
Preeclampsia
Pregnancy
Pregnancy Complications - etiology
Pregnancy Complications, Cardiovascular
Pregnancy Outcome
Pulmonary arteries
Statistical analysis
Studies
TCPC
Thromboembolism
total cavopulmonary connection
Womens health
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Summary:Objectives: To evaluate the outcome of pregnancy in women after Fontan palliation and to assess the occurrence of infertility and menstrual cycle disorders. Design and patients: Two congenital heart disease registries were used to investigate 38 female patients who had undergone Fontan palliation (aged 18–45 years): atriopulmonary anastomosis (n  =  23), atrioventricular connection (n  =  5) and total cavopulmonary connection (n  =  10). Results: Six women had 10 pregnancies, including five miscarriages (50%) and one aborted ectopic pregnancy. During the remaining four live-birth pregnancies clinically significant complications were encountered: New York Heart Association class deterioration; atrial fibrillation; gestational hypertension; premature rupture of membranes; premature delivery; fetal growth retardation and neonatal death. Four of seven women who had attempted to become pregnant reported female infertility: non-specified secondary infertility (n  =  2), uterus bicornis (n  =  1) and related to endometriosis (n  =  1). Moreover, several important menstrual cycle disorders were documented. In particular, the incidence of primary amenorrhoea was high (n  =  15, 40%), which resulted in a significant increase in age at menarche (14.6 (SD 2.1) years, p < 0.0001, compared with the general population). Conclusion: Women can successfully complete pregnancy after adequate Fontan palliation without important long-term sequelae, although it is often complicated by clinically significant (non-)cardiac events. In addition, subfertility or infertility and menstrual disorders were common.
ISSN:1355-6037
1468-201X
DOI:10.1136/hrt.2005.085407