Pulmonary Stenosis Ups Obstetric Risks


STOCKHOLM — Pregnancy in women with isolated congenital pulmonary valve stenosis is associated with an extremely high rate of obstetric and fetal complications, Willem Drenthen, M.D., reported at the annual congress of the European Society of Cardiology.

The specific nature of these complications varies depending on whether the congenital heart defect was surgically corrected before pregnancy, said Dr. Drenthen of University Medical Center, Groningen, the Netherlands.

It has generally been assumed that pregnancy in women with isolated congenital pulmonary valve stenosis is well tolerated. Data from a Dutch national registry indicate otherwise. The registry has documented 81 completed pregnancies in women with this congenital heart defect. A total of 44 cases involved those whose valvular anomaly was surgically corrected before pregnancy. Women who had not undergone surgery had only a mild pulmonary valve gradient.

Roughly 60% of the pregnancies involved at least one obstetric and/or neonatal complication. Particularly striking were the high incidence of pregnancy-induced hypertension in women with uncorrected congenital pulmonary valve stenosis, as well as the markedly elevated rates of preterm labor, preterm delivery, and postpartum hemorrhage in patients with a corrected heart defect. (See chart.) Four percent of newborns had congenital heart disease. The neonatal mortality rate was 5%, with deaths due to immaturity, meningitis, and hydrocephalus combined with prematurity.

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