Delivery of normal fetus in a woman with a cyanotic congenital cardiac anomaly

Abstract AR

This is a description of the management of a 23-year-old patient who had undergone a Glenn procedure (cavopulmonary anastomosis) and subsequently became pregnant.

The patient had a diagnosis of univentricle associated with severe pulmonic stenosis.

She had a history of mild cyanosis and three consecutive abortions postoperatively.

Her red blood count, hemoglobin, and hematocrit values were elevated, and the arterial blood O2 saturation was 86%.

She sought medical advice prior to her next pregnancy.

Repeated phlebotomies were performed until the hemoglobin was 14 g/dl and the hematocrit was 43%.

The patient was prescribed aspirin 100 mg daily immediately following the diagnosis of her first post-phlebotomy pregnancy.

During this time, her hematocrit was maintained below 44%.

At the beginning of her ninth gestational month, fetal systolic and diastolic blood flows were monitored through the umbilical arteries by pulsed wave Doppler modality.

When the chorional vascular resistance index (Pourcelot index) rose to 0.9 and disturbances in diastolic blood flows were noticed in the 37th week of gestation, the patient was delivered by cesarean section.

The newborn baby was normal on echocardiography one month after delivery.

We believe that the palliative surgical procedure (Glenn's) that the patient had undergone allowed her to reach childbearing age and played a significant role in reducing the overall risks of pregnancy, usually abundant in such a clinical setting of complex congenital cardiac anomalies.

Periodic fetal blood flow monitoring during the last month of pregnancy was helpful for the early detection of intrauterine fetal distress and reduction of perinatal mortality.