Pregnancy in the woman with congenital heart disease.

Advances in the diagnosis and treatment of congenital heart disease have improved survival for children born with complex congenital lesions. As the female patient enters adulthood, questions regarding the safety and feasibility of pregnancy arise. The hemodynamic changes of pregnancy may be well-tolerated by some patients and yet quite challenging to others. Complications may be anticipated based upon residual anatomic defects, type of surgery and sequelae of surgery. Specific congenital lesions are discussed with respect to hemodynamic changes of pregnancy in both the uncorrected and corrected states. Due to advances in diagnostic modalities, congenital heart disease may first be diagnosed in the adult patient during pregnancy. The risk of pregnancy in these women has not yet been completely defined as there is not a large experience regarding the more complicated lesions. Women should have a thorough preconception evaluation and be counselled about their potential risks. They should also be counselled that their fetus has an increased risk of congenital heart disease. Management during pregnancy, labor and delivery depends upon the specific cardiac problem. It must be individualized for the patient and formulated from a multidisciplinary approach involving obstetrics, cardiology and anesthesia.