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The Impact of Pulmonary Hypertension in Pregnancy with Congenital Heart Disease from Fetomaternal Outcomes Perspective

Author : M. R. Amalia, M. B. A. Pramono, S. B. Utami
Upload Date : 19-04-2018

Objective : Women in pregnancy with congenital heart disease have a higher risk of mortality and morbidity, especially when significant pulmonary hypertension has developed. Moreover, the fetal outcomes from such condition are also at risk. Prematurity and low birth weight are two amongst other major outcomes exist in pregnancy with congenital heart disease. This study aim to find the most frequent fetomaternal outcomes occured in such pregnancy.

Material and Method : This is an observational retrospective study based on medical records from pregnancy with congenital heart disease in Dr. Kariadi General Hospital Semarang by the year of 2015-2017.  This study used cross-sectional analysis with fisher exact test and t test for bivariate analysis. We have selected 30 pregnancies with congenital heart disease, and there are 18 patients have developed significant pulmonary hypertension. Criteria of pulmonary hypertension by echocardiography is taken from ESC* 2015 guidelines of pulmonary hypertension. 

Result : There are 30 patients selected and we find the most frequent number is Atrial Septal Defect (ASD) with 11 patients, 8 patients with Ventricle Septal Defect (VSD), and 5 patients with Tetralogy of Fallot. We find 18 patients have deleveloped significant pulmonary hypertension, which is determined by echocardiography as intermediate and high probability for pulmonary hypertension. The most significant maternal outcome is the delivery method taken, which is by abdominal delivery or surgery (87.5%) compared to vaginal delivery (12.5%) with p 0.005. The most significant fetal outcome is  low birth weight in patients with significant pulmonary hypertension with p 0.0001, also we find APGAR score for vigorous baby and asphixia is equal in pulmonary hypertension with p 0.004.

Conclusion : Women in pregnancy with congenital heart disease could develop significant pulmonary hypertension which may cause risks for fetomaternal outcomes. We find delivery method is significantly affected by pulmonary hypertension occurence and also low birth weight for fetal outcome.

KEYWORDS : congenital heart disease, pulmonary hypertension, pregnancy


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