Pregnancy in Adults with Congenital Heart Disease
As a result of medical and surgical advances, there is an increasing number of women with congenital heart disease (CHD) surviving to childbearing age .
Maternal mortality is uncommon in patients with CHD, except in the setting of Eisenmenger syndrome, severe systemic cardiomyopathy, and Marfan syndrome with aortopathy.
Maternal hypoxemia is associated with high incidence of fetal loss, even in the absence of Eisenmenger physiology. In a series of 90 patients, the rate of live births decreased to below 20% when maternal resting oxygen was <85% .
A multidisciplinary approach to the pregnant woman with CHD is essential for favorable maternal and fetal outcomes.
In general, for women with CHD, cesarean delivery is only recommended for obstetric reasons and for women who are on full anticoagulation during delivery, due to the risk of fetal intracranial hemorrhage .
The recent American Heart Association (AHA)  and European Society of Cardiology  guidelines do not support the use of antibiotic prophylaxis during vaginal delivery, owing to the limited data. However, for those at highest risk of an adverse outcome, such as patients with Eisenmenger syndrome or cyanosis, it can be considered at the time of rupture of membranes .
American Heart Association
Canadian Cardiac Disease in Pregnancy
Congenital heart disease
World Health Organization
Red blood cell
Systemic vascular resistance
Zwangerschap bij Aangeboren HARtAfwijkingen
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