What Are the Key Points in Counseling Young Adult Women with Congenital Heart Disease Concerning Contraception and Pregnancy?
In 2001, cardiac disease is the most important nonobstetrical cause of death in pregnancy, with congenital heart disease accounting for > 50% of cases. It is imperative that expertise in both counseling and management be made available to these patients. Planned pregnancies allow for lesion-specific, individualized prepregnancy counseling to determine the risk to maternal and fetal health and the implications for function of the family unit. The primary determinants of maternal morbidity and mortality are: Functional class III or IV. Pulmonary hypertension ≥ 1/2–2/3 systemic pressure. Cyanosis. Poorly controlled arrhythmias. Significant left heart obstruction. Patients can be triaged to low risk (mortality < 1%), intermediate risk (mortality 5%–15%), and high risk (mortality 25%–50%) groups. Fetal outcome is based on genetic risk, teratogenic exposure (drugs and radiologic interventions), and maternal hemodynamics. The effects of deteriorating maternal health or death and the demands o
