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Evaluation and Management of Maternal Congenital Heart Disease: A Review

Hopkins, Maeve, K., MD, MA*; Goldstein, Sarah, A., MD; Ward, Cary, C., MD; Kuller, Jeffrey, A., MD§

Obstetrical & Gynecological Survey: February 2018 - Volume 73 - Issue 2 - p 116–124
doi: 10.1097/OGX.0000000000000536
CME ARTICLES
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CME

Objective Congenital heart defects represent the most common major congenital anomalies. The objective of this review was to define the most common forms of congenital heart disease (CHD) in pregnancy, outline preconception counseling, discuss the associated morbidity and mortality of each lesion, and review current recommendations for management of CHD in pregnancy.

Evidence Acquisition A MEDLINE search of “congenital heart disease in pregnancy” and specific conditions in pregnancy including “ventricular septal defect,” “atrial septal defect,” “left outflow obstruction,” “right outflow obstruction,” “tetralogy of Fallot,” and “transposition of the great vessels” was performed.

Results The evidence included in the review contains 18 retrospective studies, 8 meta-analyses or systematic reviews or expert opinions, 5 case reports including surgical case reports, 2 prospective studies, and 2 clinical texts.

Conclusions Given advances in surgical and medical management, women with a history of congenital cardiac defects are more frequently reaching childbearing age and requiring obstetric care. Many women with CHD can have successful pregnancies, although there are a few conditions that confer significant maternal risk, and pregnancy may even be contraindicated. Appropriate care for women with CHD requires a knowledge of cardiac physiology in pregnancy, the common lesions of CHD, and coordinated care from cardiology and maternal-fetal medicine specialists.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to compare pregnancy risks among varying types of the most common maternal CHD; apply criteria of relative and absolute contraindications to pregnancy when performing preconception counseling to women with CHD; interpret for patients and other health providers the prognosis, management, and expectations of pregnancies with women with the most common types of CHD; and select relevant imaging studies, tests, and appropriate consultations and referrals when caring for women with maternal CHD.

*Resident, Department of Obstetrics and Gynecology; †Fellow and ‡Associate Professor, Division of Cardiology, Department of Internal Medicine; and §Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Maeve K. Hopkins, MD, MA, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadephia, PA 19104. E-mail: maeve.hopkins@uphs.upenn.edu.

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