Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair

Matthew Cauldwell, Philip J. Steer, Samantha Bonner, Omar Asghar, Lorna Swan, Kenneth Hodson, Catherine E.G. Head, Adam Daniel Jakes, Nicola Walker, Margaret Simpson, Aidan P. Bolger, Farah Siddiqui, Katherine M. English, Lucy Maudlin, Dilip Abraham, Andrew J. Sands, Aarthi R. Mohan, Stephanie L. Curtis, Louise Coats, Mark R. Johnson*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)401-406
Number of pages6
JournalHeart
Volume104
Issue number5
Early online date27 Sep 2017
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Fontan procedure
  • perinatal mortality
  • pregnancy

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