Pregnancy in a woman with uncorrected tetralogy of fallot

Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease after 1 year of age, with overall incidence approaching 10% of all congenital heart disease. Natural survival (i.e. without corrective procedure) into the fourth decade is extremely rare (only about 3%), but there is a tendency of increasing number of women with cyanotic congenital heart disease living 3 to 4 decades and are becoming pregnant. Because of significant physiology adaptation and changes, pregnancy and delivery process are troublesome for mostly unhealthy women, including those with uncorrected ToF. For ToF patients, it remains an important cause of maternal morbidity (62,5%), and even mortality (10%) and has significant effects on fetal outcome. Discussed below a case of pregnancy in a 28 year old woman with uncorrected ToF, was diagnosed to have pneumonia, ToF-class III-IV of New York Heart Association, secondary polycythemia caused by hypoxia, and uncompensated metabolic acidosis on 25th week pregnancy. Through delicate medical care, patient's condition improvement can be seen. Patient decided to continue the pregnancy. Without optimal either obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor.