Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair. Issue 5 (27th September 2017)

• Record Type: Journal Article
• Authors: Cauldwell, Matthew; Steer, Philip J; Bonner, Samantha; Asghar, Omar; Swan, Lorna; Hodson, Kenneth; Head, Catherine E G; Jakes, Adam Daniel; Walker, Nicola; Simpson, Margaret; Bolger, Aidan P; Siddiqui, Farah; English, Katherine M; Maudlin, Lucy; Abraham, Dilip; Sands, Andrew J; Mohan, Aarthi R; Curtis, Stephanie L; Coats, Louise; Johnson, Mark R
• Is Part Of: Heart. Volume 104:Issue 5(2018)
• Page Start: 401
• Page End: 406
• Publication Date: 2017-09-27
• Subjects: Fontan procedure -- pregnancy -- perinatal mortality; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2017-311763
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: The population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK. Methods: A retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK. Results: 50 women had 124 pregnancies, resulting in 68 (54.8%) miscarriages, 2 terminations of pregnancy, 1 intrauterine death (at 30 weeks), 53 (42.7%) live births and 4 neonatal deaths. Cardiac complications in pregnancies with a live birth included heart failure (n=7, 13.5%), arrhythmia (n=6, 11.3%) and pulmonary embolism (n=1, 1.9%). Very low baseline maternal oxygen saturations at first obstetric review were associated with miscarriage. All eight women with saturations of less than 85% miscarried, compared with 60 of 116 (51.7%) who had baseline saturations of ≥85% (p=0.008). Obstetric and neonatal complications were common: preterm delivery (n=39, 72.2%), small for gestational age (<10th percentile, n=30, 55.6%; <5th centile, n=19, 35.2%) and postpartum haemorrhage (n=23, 42.6%). There were no maternal deaths in the study period. Conclusion: Women with a Fontan circulation have a high rate of miscarriage and, even if pregnancy progresses to a viable gestational age, a high rate of obstetric and neonatal complications.