PREGNANCY IN PATIENTS WITH CONGENITAL HEART-DISEASE

A process of adaptation of the cardiovascular system occurs during pregnancy, entailing physiologic changes. In women with congenital heart disease these changes lay a great burden on the cardiovascular system. Therefore there is an increased risk for mother and fetus, depending on the form of congenital heart disease, preceding operations and the grade of maternal hypoxemia. Overall, the maternal mortality is low, but in certain forms of congenital heart disease the mortality rate can rise to 50%. Infective endocarditis and anticoagulation therapy represent further problems for mother and fetus. It is the duty of the cardiologist, general practitioner and obstetrician to counsel the patient before conception on potential complications and risks of pregnancy, expected physical deterioration of the mother, as well as possible malformations of the child, including the recurrence risk of congenital heart disease. If pregnancy is contraindicated because of the severity of the heart disease, the patient has to be advised about reliable contraceptive methods tailored to her individual needs and their risks, including possible endocarditis, bleeding under anticoagulation therapy, thrombosis, toxic shock syndrome etc.