Pregnancy post Fontan

Now we don’t need to worry about Olivia even thinking about becoming pregnant for many, many years. However, we have been told that single ventricle patients are discouraged from getting pregnant because of the risks associated with their hearts.

I came across this on one of the message boards I post at:


Anaesthesia
Volume 60 Issue 11 Page 1137 - November 2005
doi:10.1111/j.1365-2044.2005.04334.x

CASE REPORT
Caesarean section following the Fontan procedure: two different deliveries and
different anaesthetic choices in the same patient L. Eid1, Y. Ginosar2, U.
Elchalal3, A. Pollak4 and C. F. Weiniger5

Summary

The Fontan procedure is performed for patients with a hypoplastic right
ventricle, and pregnancies following this palliative surgery are likely to
increase. We present a parturient with the Fontan physiology who successfully
underwent two consecutive caesarean deliveries; the first under general
anaesthesia for emergency surgery and the second under regional anaesthesia for
elective surgery. We suggest that pregnancy and delivery do not typically
adversely affect maternal cardiac status in these patients. Attention must be
paid, however, to fetal loss, prematurity, growth retardation and associated
cardiac congenital malformations for which insufficient data exist in the
literature in this patient population.

I emailed this information to Olivia's cardiologist to see what her take was. She responded with the following:

Here is what I found in the medical literature last time I searched this topic
(a few years ago):

The largest, most often cited study of pregnancy in Fontans was published in
1996, looking at 33 pregnancies in 21 single ventricle mommies. There were
13 miscarriages, 5 abortions (10 or 15 years ago, these women were often
counselled that pregnancy put their own life in danger) and 15 live births,
ranging from 28 weeks gestation to full term. No maternal mortality, one
complication (arrythmia). The big difference between these patients and
our current "crop" of Fontans, is that most of them had their Fontans as
teenagers or young adults, so they lived with cyanosis for many years before
getting fixed.

A more recent article (2001) reports 4 "successful" pregnancies in 3 Fontan
patients. The babies were all premature (26-35 weeks), there were some maternal
complications (arrhythmia, ventricular dysfunction, and fluid build up) but all
were medically managed - no mortality.

So, bottom line..... Cautious Optimism! I expect in 20-30 years, Pregnancy in
Fontans will be much more common place and not so scary. By then we will figure
out how to optimize the outcome for mom and baby.

So with medical advances, Olivia's chances of becoming a mom herself are very good! :)

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