CONGRESS ABSTRACT

Introduction Cardiovascular risk in pregnancy is rising, driven by a higher average maternal age at first conception and an increasing number of women with congenital heart defects (CHD) who are successfully completing pregnancies. Furthermore, for a fetus with a prenatal diagnosis of CHD, giving birth in a center with integrated congenital cardiac care is essential. Methods In 2025, we managed 52 pregnancies involving either maternal heart disease or a fetus with CHD. A dedicated Pregnancy Heart Team, consisting of a cardiologist, gynecologist, obstetrician, anesthetist, and neonatologist, provided multidisciplinary care. The management for each patient was a collegial process, adhering to the criteria defined by WHO and ESC guidelines. Follow-up during pregnancy was conducted quarterly or, in some cases, monthly, always involving the multidisciplinary team. The timing of delivery was within the 40th week. Both spontaneous and caesarean section deliveries were performed at our center, following distinct, dedicated pathways. Results The mean age of women delivering at our center was 33 years. Maternal heart disease affected 23% of the cases, while 40 patients (77%) had a fetus diagnosed with CHD prenatally. Maternal Heart Disease Group: 66% of these patients were classified as mWHO III, with the remainder in class II. Parity: It was the first pregnancy for 50% of the patients, the second for 36.5%, and the third or more for the remaining 12.5%. Delivery Mode: caesarean section was performed on 5 patients (9%) with maternal heart disease and 17 mothers (32.5%) carrying a fetus with CHD. Post-partum complications: Post-partum bleeding (> 500 mL) occurred in 2 patients (4%) with maternal heart disease and 9 mothers (17%) of fetuses with CHD without need of blood transfusions in any cases. Post-partum bleeding (defined as 600 mL) was observed in a total of 11 mothers. None of these cases required blood transfusions. Other Adverse Events: we recorded one case (2%) of pre-eclampsia, which did not require the intensive care unit for the mother. Conclusions Advances in the diagnosis and treatment of both congenital and acquired heart disease have enabled a growing number of women referred to our Institute to achieve a safe pregnancy outcome. This positive result is attributed to the systematic, multidisciplinary management provided by our Pregnancy Heart Team, evidenced by limited post-partum bleeding and the absence of major adverse events.