Obstetrical and Fetal Considerations
In the majority of patients, the delivery method was determined
by obstetric reasons or fetal demands. The high rate of
37.5% of cesarean sections was related to the peculiarity inherent
in pregnancy in patients with severe heart disease, associated
with retardation of fetal growth, fetal distress, and labor
induction risks. In heart disease situations, in which cesarean
section was indicated, the aim was to improve the maternal
and fetal prognosis in those very dangerous clinical settings by
reducing the gestational period. In this event, the procedure
must be carried out as soon as fetal maturity was established.
In this study, 91% of pregnancies resulted in healthy infants,
comparable with those in the general population; this was rewarding
considering the high incidence of severe cardiac disease
in this cohort. The occurrence of 4.8% of spontaneous
abortion is included in the actual rate of abortion in women
with cardiac disease since most patients were referred from the
first trimester of gestation.
Furthermore, the high incidence of fetal pathologies in
groups with congenital heart disease, hypertrophic cardiomyopathy,
and Chagas’ disease (Table I) was very strongly associated
with its genetic or infectious nature and is consistent
with other reports.35, 36 Thus, during prenatal care, a detailed
cardiac examination including serial fetal ultrasound studies
and eventually fetal echocardiography should be performed.