TY - JOUR
T1 - Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair
AU - Cauldwell, Matthew
AU - Steer, Philip J.
AU - Bonner, Samantha
AU - Asghar, Omar
AU - Swan, Lorna
AU - Hodson, Kenneth
AU - Head, Catherine E.G.
AU - Jakes, Adam Daniel
AU - Walker, Nicola
AU - Simpson, Margaret
AU - Bolger, Aidan P.
AU - Siddiqui, Farah
AU - English, Katherine M.
AU - Maudlin, Lucy
AU - Abraham, Dilip
AU - Sands, Andrew J.
AU - Mohan, Aarthi R.
AU - Curtis, Stephanie L.
AU - Coats, Louise
AU - Johnson, Mark R.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - Fontan procedure
KW - perinatal mortality
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85041701690&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2017-311763
DO - 10.1136/heartjnl-2017-311763
M3 - Article (Academic Journal)
C2 - 28954835
AN - SCOPUS:85041701690
SN - 1355-6037
VL - 104
SP - 401
EP - 406
JO - Heart
JF - Heart
IS - 5
ER -