Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
Department of Obstetrics, St Mary's Hospital Manchester, Manchester, UK.
Heart. 2018 Mar;104(5):401-406. doi: 10.1136/heartjnl-2017-311763. Epub 2017 Sep 27.
The population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK.
A retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK.
50 women had 124 pregnancies, resulting in 68 (54.8%) miscarriages, 2 terminations of pregnancy, 1 intrauterine death (at 30 weeks), 53 (42.7%) live births and 4 neonatal deaths. Cardiac complications in pregnancies with a live birth included heart failure (n=7, 13.5%), arrhythmia (n=6, 11.3%) and pulmonary embolism (n=1, 1.9%). Very low baseline maternal oxygen saturations at first obstetric review were associated with miscarriage. All eight women with saturations of less than 85% miscarried, compared with 60 of 116 (51.7%) who had baseline saturations of ≥85% (p=0.008). Obstetric and neonatal complications were common: preterm delivery (n=39, 72.2%), small for gestational age (<10th percentile, n=30, 55.6%; <5th centile, n=19, 35.2%) and postpartum haemorrhage (n=23, 42.6%). There were no maternal deaths in the study period.
Women with a Fontan circulation have a high rate of miscarriage and, even if pregnancy progresses to a viable gestational age, a high rate of obstetric and neonatal complications.
接受 Fontan 修复术的育龄妇女人数不断增加。本研究旨在描述英国 Fontan 循环患者妊娠进展及其结局。
对英国 10 家成人先天性心脏病中心的 Fontan 循环患者进行回顾性研究，这些患者在 2005 年 1 月至 2016 年 11 月期间分娩。
50 名女性共有 124 次妊娠，其中 68 次（54.8%）流产，2 次终止妊娠，1 次宫内死亡（30 周），53 次（42.7%）活产和 4 次新生儿死亡。活产妊娠的心脏并发症包括心力衰竭（n=7，13.5%）、心律失常（n=6，11.3%）和肺栓塞（n=1，1.9%）。首次产科检查时的低氧饱和度与流产有关。所有 8 名饱和度低于 85%的孕妇均流产，而 116 名饱和度≥85%的孕妇中，有 60 名（51.7%）流产（p=0.008）。产科和新生儿并发症很常见：早产（n=39，72.2%）、小于胎龄儿（<10 百分位数，n=30，55.6%；<5 百分位数，n=19，35.2%）和产后出血（n=23，42.6%）。研究期间无产妇死亡。
Fontan 循环患者流产率高，即使妊娠进展到可存活的胎龄，其产科和新生儿并发症发生率也高。
