PERINATOLOGIYA AND PEDIATRIYA.2019.1(77):5-11; doi 10.15574/PP.2019.77.5

Lazoryshynets V. V., Davydova Iu. V., Limanskaya A. Iu., Siromakha S. O.
SI «Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine», Kyiv
SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», Kyiv

Purpose — to reduce the level of maternal and infant mortality, as well as of disability in women and newborns at childbirth.

Patients and methods. From December 2013 to September 2018, 2815 pregnant women were examined, 116 of which needed hospitalization. The group of GUCH patients consisted of 64 women (61 pregnant, and 3 postpartum women), 52 of which with structural congenital heart disease (CHD), 12 with congenital conduction defects of the heart. Cardiovascular risk stratification was carried out on three scales: modified WHO scale (mWHO), as well as ZAHARA and CarPreg scales. After examination and multidisciplinary consultation of specialists, the tactics of pregnancy and childbirth management in each individual case were determined, depending on the cardiovascular and perinatal risk class, the specific clinical situation and the period of gestation. All patients were divided into the following groups according to the type of intervention: conservative (group of heart and great vessels interventions); group of caesarean section; combined surgery group (cardiac surgery with cesarean section).

Results. Currently the level of cross-sectoral specialized care provision for GUCH pregnant with 'special needs' significantly reduces the risk of mortality and disability in mother and child. The first line of protection for GUCH women of fertile age is the primary prevention of major cardiac events, in particular, preconceptual counseling on the basis of specialized expert centers and pregravidinary preparation for pregnancy, including cardiac surgery with subsequent multidisciplinary management at all stages of pregnancy, childbirth, and postpartum period.

Conclusions. Optimal management of pregnant women with congenital cardiac disease requires multidisciplinary cooperation of specialists from expert centers. The methods and tactics of GUCH pregnancies management according to existing guidelines need to be revised. Pregnant women who belong to the III–IV risk class according to the modified WHO scale should be referred to specialized institutions for expert cardiological, cardiac surgery, obstetric-gynecological and perinatal care. In the event of a life-threat to the pregnant with a high-risk cardiac disease, urgent cardiac surgery can save the mother's life, although it increases the antenatal risks for the fetus.

Key words: pregnancy, congenital heart disease, multidisciplinary care.

REFERENCES

1. Bankl H. (1980). Vrodzheni vady sertsia i krupnykh sudyn. Kyiv: Medytsyna: 312.

2. ESC. (2010). Guidelines for the management of grown-up congenital heart disease (new version 2010), European Heart Journal. 31: 2915–2957.

3. ESC. (2011). Guidelines on the management of cardiovascular diseases during pregnancy, European Heart Journal. 32: 3147–3197.

4. ESC. (2018). Guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal. 00: 1–83.

5. Hoffman JI, Kaplan S. (2002). The incidence of congenital heart disease. J Am Coll Cardiol. 39: 1890–1900. https://doi.org/10.1016/S0735-1097(02)01886-7

6. Maruszewski B et al. (2002). Congenital heart surgery nomenclature and database project: up date and proposed data harvest. European Journal of Cardiothoracic Surgery. 21: 47–49. https://doi.org/10.1016/S1010-7940(01)01082-X

7. Razzaghi H. (2015). Long-Term Outcomes in Children with Congenital Heart Disease: National Health Interview. Survey J Pediatr. 166: 119–124. https://doi.org/10.1016/j.jpeds.2014.09.006; PMid:25304924 PMCid:PMC4378575

8. Van Rijen E.H.M et al. (2003). Psychosocial functioning of the adult with congenital heart disease: a 20–33 years follow-up. European Heart Journal. 24: 673–683. https://doi.org/10.1016/S0195-668X(02)00749-2

9. Warnes CA. et al. (2001). Task Force 1: The Changing Profile of Congenital Heart Disease in Adult Life, Journal of the American College of Cardiology. 37 (5): 1161–1198. https://doi.org/10.1016/S0735-1097(01)01272-4

10. Yu C. et al. (2018). Causes of death in a contemp orary adult congenital heart disease cohort. Heart. 104: 1678–1682. https://doi.org/10.1136/heartjnl-2017-312777; PMid:29666178

Article received: Nov 18, 2018. Accepted for publication: Mar 18, 2019.