Pregnancy in patients with tetralogy of fallot: outcome and management

The objective was to evaluate pregnancy outcome in women with tetralogy of Fallot, including impact of corrective cardiac surgery on pregnancy outcome in a tertiary care referral hospital. The study was a retrospective analysis of maternal and perinatal outcome in all women with tetralogy of Fallot treated in a cardio-obstetric unit during 1996-2008. Ten women had 21 pregnancies. Of the 10 women, 7 with uncorrected tetralogy of Fallot had 16 pregnancies. Obstetric and cardiac complications were more frequent in the uncorrected group (70% vs 40% and 40% vs nil, respectively). The frequency of spontaneous abortion and preterm birth was greater in the uncorrected group (37.5% vs nil and 25% vs nil, respectively). The percentage of babies who were small for gestational age was 40% in the uncorrected group and 20% in the corrected group. Tetralogy of Fallot carries substantial risk to mother and fetus. Surgical correction is associated with improved maternal and perinatal outcome. These patients need detailed prepregnancy evaluation and should be under joint supervision of an obstetrician, a cardiologist, a congenital cardiac surgeon, and an anesthetist.