Pregnancy in Women With Congenital Heart Disease

Naveen L. Pereira, MD; Carole A. Warnes, MD


February 03, 2014

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Delivery Considerations

Dr. Pereira: That is wonderful and useful information. A question that often comes up is how to advise the treating obstetrician about delivery in a woman with congenital heart disease. Should she be delivered vaginally or by cesarean section? How do you make that decision for a specific patient?

Dr. Warnes: Another common myth is that all women with heart disease must be delivered by cesarean section. That isn't true. The blood loss from a cesarean section is higher than from a vaginal delivery.

Most women can deliver safely vaginally. Having said that, it is preferable for labor to be relatively short so that these women are not in labor for 24, 36, or 48 hours, because of the hemodynamic changes that happen very abruptly during labor and delivery. Most women can anticipate a vaginal delivery unless there is an obstetric reason for an operative delivery.

The indications for cesarean delivery are a dilated aorta (when you want to avoid excessive Valsalva maneuvering -- essentially pushing for a long period of time) and pulmonary hypertension, so that you have cardiac obstetric anesthesia, and the whole team there to save the life of the mother if there is a period of hemodynamic perturbation.

Aortic stenosis -- a stenotic lesion with decompensation -- is another indication for operative delivery. Some women with complex congenital heart disease might not tolerate going 40 weeks to term, and we need to deliver the baby earlier. If the mother's cervix isn't ready, we might need to do a cesarean section, if necessary, to deliver the baby and minimize the hemodynamic perturbations if the mother is starting to decompensate.


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