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The 3rd International Congress on Cardiac Problems in Pregnancy – Venice 2014

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The 3rd International Congress on Cardiac Problems in Pregnancy – Venice 2014

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  1. Outcomes of pregnancy in women after Fontan palliationMarielle Gouton, MagalieLadouceur, Jacky Nizard, Marc DommerguesCentre Chirurgical Marie Lannelongue – Le Plessis-RobinsonHôpitalEuropéen Georges Pompidou – Paris GroupementHospitalier La Pitié-Salpêtrière – ParisFrance The 3rd International Congress on CardiacProblems in Pregnancy – Venice 2014

  2. Design • Outcomes of all pregnancies in women with Fontan palliation in France • Methods : • Retrospective study • French M3C centers • 2001-2013 • All known pregnancies • Cardiac, obstetrical and neonatal complications • Pre-partum, peri-partum, post-partum, follow-up Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  3. Population • 27 women, 41 pregnancies (1 twin-pregnancy) • 4 / 27 (15 %) had previous infertility • 9 had 2 pregnancies or more • Age at first pregnancy : 20 – 41 y (mean 27± 5) Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  4. Population Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  5. Results : 41 pregnancies 58 % 33 % Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  6. Maternal complications10 / 41 (25 %) Outcomes of pregnancy in womenafterFontan palliation – 3rd International Congress on CPP – Venice 2014

  7. Obstetrical complications 25 / 41 (61 %) Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  8. Anticoagulation ? Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  9. Post-natal follow-up • Mode of delivery : • Vaginal : 12 • Cesarean section : 12 • Mean gestational age : 34 (±3) w • Mean birth weight : • 2024 (±690) g (10th percentile) • Prematurity : 17 / 24 (70 %) • 33-36+6 w : 11 • 28-32+6 w : 5 • 22-27+6 w : 1 • Neonatal death : 1 (birth at 25 w) • Twins : birth by cesarean section at 32 w • Recurrence of congenital heart disease : • 1 left superior vena cava • (fetal death : tricuspid atresia) Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  10. Maternalfollow-up • Post-partum complications • Parietal hematoma :1 • Fontan failure: 1 • ↗NYHA: 1 • 21 / 27 women (75%) have ≥ 1 newborn • 0 newborn : 6 • 1 newborn : 18 (1 neonatal death) • 2 newborns : 3 • Late follow-up : 43 months (1 – 144) • Fontan failure : 2 • No maternaldeath Le switch a 30 ans ! Atelier-débat - CCML 6 et 7 février 2014

  11. Fontan and pregnancy: Is it possible ? • Yes, but only if : • Pre-conception visit • Cardiac function • Ventricular function (echo, MRI) • TCPC function • AV valve insufficiency • Counseling • High risk of maternal complications • Arrhythmia • Thromboembolism • Therefore: anticoagulation • High risk of miscarriage (33%) • High risk of prematurity (70%) • Risk of recurrence • Multidisciplinary follow-up (tertiary hospital) • Adult cardiac congenitalist • Obstetrician • Anesthesiologist • Neonatologist • Vaginal delivery if obstetrician agrees Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

  12. Fontan and twin pregnancy ?Yes, they can Outcomes of pregnancy in women after Fontan palliation – 3rd International Congress on CPP – Venice 2014

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