A retrospective survey of adverse maternal and neonatal outcomes for parturients with congenital heart disease.

BACKGROUND: Parturients with congenital heart disease are at increased risk of maternal cardiac and neonatal complications. There is a paucity of literature regarding the relationship of complications with the type of anesthesia or mode of delivery.

METHODS: We retrospectively reviewed all parturients with congenital heart disease undergoing delivery over a 7-year period at Tokyo Women's Medical University, Maternal and Perinatal Center to identify maternal cardiac and neonatal complications occurring during the peripartum period.

RESULTS: Of 151 pregnancies in 128 women with congenital heart disease, there were 84 vaginal and 67 cesarean deliveries. Cesarean deliveries were performed with either neuraxial (n=51) or general (n=16) anesthesia. There were no maternal deaths and two neonatal deaths (one vaginal; one cesarean delivery). The incidence of maternal cardiac events was 1 in 84 (1%) for vaginal deliveries and 10 in 67 (15%) for cesarean deliveries. Neonatal complications occurred in 11 of 84 (13%) pregnancies with vaginal delivery and 25 of 67 (37%) pregnancies with cesarean delivery. Twenty-three elective cesarean deliveries occurred for maternal cardiac problems and were associated with a significant incidence of maternal cardiac (35%) and neonatal (65%) complications. The incidence of maternal cardiac events during delivery, when stratified by severity of cardiac disease, was similar to a previously derived cardiac risk index for pregnant women with cardiac disease.

CONCLUSION: Despite a low overall incidence of maternal and neonatal mortality, pregnancy in women with congenital heart disease was associated with significant maternal cardiac and neonatal complications. Elective cesarean delivery with neuraxial anesthesia was a common approach for high-risk parturients with congenital heart disease; however, the benefit of this mode of delivery and anesthetic technique could not be ascertained.