Vol. 40 | No. 1 | January-June 2012 Back

Open Access

Clinical Profile and Outcomes of Pregnant Patients with Congenital Heart Disease at the University of the Philippines Philippine General Hospital

Michael T. Reyes, Ronald B. Capito, Felix Eduardo R. Punzalan
Jun 2012 DOI 10.69944/pjc.122468810e

Abstract

BACKGROUND: Recent advances in the management of congenital heart diseases (CHD) have emerged. However, most CHD patients in a developing nation like the Philippines cannot afford proper treatment. If a CHD patient then desires children, greater problems may arise during pregnancy. Hence, it may be meaningful to describe the clinical profile and management of commonly - seen CHD patients during pregnancy. 

METHODS: This is a cross-sectional retrospective study of all admitted pregnant patients with CHD diagnosed by 2D-echocardiography at the University of the Philippines-Philippine General Hospital, from July 2009 to October 2011. Data on demographics, type of congenital lesion, common medications, maternal complications and pregnancy outcomes were collected and described. 

RESULTS: Forty-four patients of CHD in pregnancy were included in this study. The median age of the patients was 24 years old, and the median age of gestation at the time of consult was 37 weeks. The most common reason for consult was labor (64%), with one-fourth of them in preterm labor. Majority of patients (95%) knew about their CHD prior to pregnancy, and half of them noted worsening of failure symptoms during pregnancy. The most common congenital lesions encountered were atrial septal secundum defects (37%) and patent ductus arteriosus (20%). Digoxin was the most frequently prescribed drug (27%). Infective endocarditis prophylaxis was given 55% of the time. Assisted vaginal delivery (41%) was the most common manner of delivery, with continuous epidural anesthesia (82%) as the most common route for anesthesia delivery. Maternal complications occurred in 9% and preterm birth in 25%. A third of all neonates (13) delivered were small for gestational age, and 66% of these babies had moderate to severe pulmonary artery hypertension. 

CONCLUSION: Pregnancies with CHD carry significant rates of preterm births and SGA babies. Adverse events and maternal complications were observed mostly in patients with moderate to severe pulmonary hypertension. Female CHD patients should be educated about the risks of pregnancy and the benefits of prevention of pregnancy, especially in patients with moderate and severe pulmonary hypertension. 

KEY WORDS: Cardiovascular disease in pregnancy; High-Risk pregnancies; Congenital Heart Disease

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