Follow up and Delivery in Women Suffering from theCoarctation of the Aorta: the Outcome of 64Pregnancies in 41 Women

Overview

Objective:
To evaluate maternal morbidity and mortality of women suffering from coarctation ofthe aorta as well as the perinatal mortality of babies delivered by women with this anomaly of theaorta. According to our experience we recommend a suitable form of a follow up and suggest anoptimal mode of delivery for these patients.Design: Original paper.Setting: 1 st and 2 nd Department of Gynecology and Obstetrics of the Masaryk University of Brno -Maternity Hospital, Obilní Trh 11, 602 00 Brno, Czech Republic.Methods: Our set consists of 34 pregnant women with coarctation of the aorta. These patientswere followed up during the pregnancy in the years 1964 - 1998 by the Centre for CardiovascularDiseases in Pregnancy in the Maternity Hospital in Brno. Seven women who were not operated onfor the coarctation of the aorta (group A) were pregnant 14 times. Twenty seven women who wereoperated on for the coarctation (group B) had 50 pregnancies.Results: There were no maternal deaths in our set. From the 12 delivered babies of women withnon operated coarctation of the aorta one child was SGA (small for gestational age). From 42babies born by women who underwent an radical operation of the coarctation of the aortapreviously we had to face one death of a newborn who was SGA as well.Conclusion: The radical operation of the aorta should be carried out during the first year of age ifpossible, between the 9th to 12th month, at best. With women who were not operated on there isa greater risk of rupture of the aneurysm of the aorta and aneurysm of the cerebral arteries in the2 nd and 3 rd trimestr, during the labor and in the early puerperium. We would advise thereforea thorough follow up during the whole pregnancy. The high BP should be lowered medicamental-ly. As to the mode of delivery Caesarean section is preferred. With women who were successfullyoperated on in their early infancy and whose BP is normal or the systolic BP does not exceede 160mmHg the Caesarean section is not mandatory but elective. We would mostly advise a spontane-ous delivery with shortening of the 2 nd stage of the labor by forceps or vacuumextraction - thedelivery by Caesarean section in accordance with usual obstetrical practice.

Key words:
coarctation of the aorta and pergnancy, follow up, mode of delivery, cerebral aneu-