CONGRESS ABSTRACT

Introduction The risk of cardiovascular disease during pregnancy has progressively increased due to the rise in the average age of the first conception as well as the ever-growing number of women with congenital heart disease able to face a pregnancy. The choice of delivery in a woman with heart disease represents one of the fundamental decisions on the correct management of this type of patients. Materials and Methods From 2016 to 2023, 67 pregnancies of patients affected by congenital or acquired maternal heart disease were managed in our Center. Patients were followed by a dedicated heart pregnancy team composed of a cardiologist, gynecologist, obstetrician, anesthetist and neonatologist. The evaluation was collegial for each patient trying to implement the criteria defined by the WHO and ESC guidelines. The follow-up during pregnancy was mostly quarterly or in some cases monthly, always multidisciplinary, and timing of delivery took place within the thirtieth week. Both spontaneous and caesarean section delivery took place in our Center with a dedicated path for each solution. Results The average age of women with congenital and acquired heart disease who gave birth in our Center was 33 ± 13 years. The patients had cardiac pathologies of variable severity: 34% fell into classes I and II of the mWHO classification, 56% were in risk class III while 10% were in class IV. The gestational age at delivery was on average 38 weeks ± 3 days. In 52% of the patients it was a first pregnancy, in 40% of the cases it was a second pregnancy, while in the remaining 8% of the cases the patients were in their third or more pregnancies. 51 patients (74%) underwent caesarean section, 15 patients (22%) had a spontaneous birth and 3 patients (4%) by vacuum. The average neonatal weight at birth was 2.9 ± 0.6 kg with an average Apgar score of 9 at birth. No adverse events were recorded for either mothers or newborns at the time of delivery. Conclusions The improvement in the diagnosis and treatment of congenital and acquired heart disease together with the evolution of assisted reproduction techniques has allowed a growing number of women with heart disease of childbearing age to reach the goal of a safe pregnancy. This result was achievable thanks to a systematic multidisciplinary management which allowed also absence of adverse events for both the mother and the fetus at the time of delivery, with a prevalence of deliveries by caesarean section compared to spontaneous ones.