Uebing et al identified common risk factors in a pregnant woman with congenital heart disease that can have significant adverse effects on the fetus. These can help identify a woman who should have a careful evaluation of the fetus during the pregnancy. The authors are from the Imperial College and Chelsea and Westminster Hospital in London.
Parameters:
(1) New York Heart Association functional status
(2) cyanosis
(3) left heart outflow obstruction
(4) maternal age
(5) cigarette smoking
(6) anticoagulant therapy
(7) systemic hypertension
(8) beta-blocker therapy
|
Parameters |
Findings |
Points |
|
NYHA functional class |
I or II |
0 |
|
|
III or IV |
1 |
|
cyanosis |
absent |
0 |
|
|
present |
1 |
|
left heart outflow obstruction |
absent |
0 |
|
|
present |
1 |
|
maternal age |
< 20 years |
1 |
|
|
20 - 35 years |
0 |
|
|
> 35 years |
1 |
|
cigarette smoking |
none |
0 |
|
|
present |
1 |
|
anticoagulant therapy |
absent |
0 |
|
|
present |
1 |
|
systemic hypertension |
absent |
0 |
|
|
present |
1 |
|
beta-blocker therapy |
absent |
0 |
|
|
present |
1 |
where:
• Left heart outflow obstruction may include (a) mitral valve area < 2 square cm, (b) aortic valve area < 1.5 square cm, (c) left ventricular outflow tract peak blood pressure gradient before pregnancy > 30 mm Hg
Other risk factors not listed:
(1) ethanol abuse
(2) cocaine, methamphetamine or other drug abuse
(3) gestational diabetes
number of risk factors for adverse fetal effects =
= SUM(points for all of the parameters)
Interpretation:
• A woman with one or more risk factors should have close monitoring during the pregnancy with regular fetal assessments.
Specialty: Obstetrics & Gynecology
ICD-10: ,
