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The Critically Ill Pregnant ACHD Patient

  • Lucia Baris
  • Jolien W. Roos-HesselinkEmail author
Chapter
Part of the Congenital Heart Disease in Adolescents and Adults book series (CHDAA)

Abstract

Increasing numbers of women with congenital heart disease (CHD) reach childbearing age. Therefore, pregnancies in these women are an emerging entity in the management of grown-up congenital heart disease (GUCH) or adult with congenital heart disease (ACHD). Pregnancy in women with CHD is associated with increased risks of cardiac, obstetric, and fetal adverse events and should therefore be discussed preferably before pregnancy. Individual risk assessments can be made using the modified World Health Organization classification and management should be performed accordingly. However, we do see a significant number of women with congenital heart disease who present being already pregnant, and sometimes the first presentation happens as an already critically ill patient. Cardiac emergencies like acute heart failure, arrhythmias, acute myocardial infarctions, or aortic dissections should be treated immediately but with consideration of the unique situation of pregnancy, taking into account not only the maternal outcome but also the effects on the fetus, which might introduce also ethical challenges. In this chapter, the treatment of the critically ill pregnant patient with CHD will be discussed, with special focus on specific high-risk conditions.

Keywords

Adult with congenital heart disease Pregnancy High risk Fetus Ethics Adverse effects Arrhythmia Heart failure Acute myocardial infarction Aortic dissection Thromboembolism 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CardiologyErasmus UniversityRotterdamThe Netherlands

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