In pregnant women with heart disease requiring intervention, cardiac surgery carries significant fetal risks despite acceptable maternal mortality, while radiation from common percutaneous interventions does not cause detectable fetal harm.
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Supports percutaneous approaches to limit fetal risk in pregnancy; leaves open need for prospective trials on optimal strategies.
In pregnant women with heart disease, complications can arise due to the haemodynamic burden of pregnancy and to hypercoagulation. Most problems can be managed medically, but sometimes cardiac surgery or percutaneous intervention is unavoidable. Cardiac surgery has similar maternal mortality to that outside pregnancy, but foetal mortality and morbidity are considerable. Measures to reduce the risk by adaptation of the management of cardiopulmonary bypass are described. When gestational age is > 28 weeks, pre-surgery delivery of the foetus should be considered. Percutaneous intervention exposes the foetus to radiation. The radiation dose for common cardiac procedures, however, does not result in detectable harmful foetal effects.
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Pieper et al. (2012) studied this question.
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