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Pregnancy and Women with Congenital Heart Disease

Pregnancy and Women with Congenital Heart Disease - What it is

Congenital heart disease refers to heart defects that exist since birth. The incidence of congenital heart disease in Singapore is 0.8 per cent of total live births. Improvements in the modern medicine in the past decades have increased the survival of patients with congenital heart disease. As such, although women with congenital heart disease will have a higher risk of developing complications – anemia, bleeding, high blood pressure and premature birth – during pregnancy and delivery, most can still have a successful pregnancy, as long as there are careful planning and discussion.

Pregnancy and Delivery for Women with Congenital Heart Disease

Planning pregnancy
Please consult with your cardiologist if you are considering pregnancy. Your cardiologist understands your heart condition(s) and will explain the effect of pregnancy on your health.

Ideally, your pregnancy should be planned before conception. An echocardiogram (ultrasound of the heart) or other tests may be performed to assess if your heart will be able to cope with the extra demand during pregnancy. Your cardiologist will then advise you on the risks and whether pregnancy is safe for you. For some heart conditions, your cardiologist may discuss the timing for surgery to improve your heart function before pregnancy.

It is important for any woman that is planning pregnancy to start observing a healthy lifestyle which includes eating healthily, exercising regularly, avoiding smoking and excessive intake of alcohol.

During pregnancy
There will be an increased demand on your heart during pregnancy. You should visit your obstetrician and cardiologist early, at about six to seven weeks of pregnancy. They will plan your check-ups and scans depending on your heart condition(s). Your cardiologist will listen to your heart and lungs, and ask for symptoms of shortness of breath, irregular heartbeat and exercise tolerance (when climbing the stairs or walking at a normal pace). Your blood pressure and heartbeat will also be measured.

During delivery
Natural birth or vaginal delivery is safe for the majority of women with congenital heart disease. It is important to limit the demand on the heart and thus, good pain relief may be necessary. It is essential to discuss with your obstetrician the various aspects of delivery including the planning and timing of delivery, and the methods of pain relief. For some women, the antibiotic prophylaxis is recommended before labour starts to prevent endocarditis.

Women with congenital heart disease may need to have a slightly longer stay in the hospital after their delivery to allow the heart to normalise to pre-pregnancy levels.

Cardiac-Obstetric Clinic 
National Heart Centre Singapore (NHCS) and the Department of Obstetrics & Gynaecology from Singapore General Hospital run a monthly specialised joint Cardiac-Obstetric Clinic on the last Monday morning of the month to see all pregnant patients with heart disease. Over the last 10 years, we have managed 200 to 300 pregnant patients with varying severity of cardiac problems through their pregnancy with successful outcomes.

Pregnancy and Women with Congenital Heart Disease - Symptoms

Pregnancy and Women with Congenital Heart Disease - How to prevent?

Pregnancy and Women with Congenital Heart Disease - Causes and Risk Factors

Pregnancy and Women with Congenital Heart Disease - Diagnosis

Diagnosis of adult congenital heart disease (ACHD) normally starts with a physical examination by a doctor, assessment of your medical history, followed by routine tests. Other recommended tests may include:

Pregnancy and Women with Congenital Heart Disease - Treatments

Pregnancy and Women with Congenital Heart Disease - Preparing for surgery

Pregnancy and Women with Congenital Heart Disease - Post-surgery care

Pregnancy and Women with Congenital Heart Disease - Other Information

NHCS Adult Congenital Heart Disease (ACHD) Programme

This programme was first started in 2003 and currently offers:
  • ACHD clinic on every Wednesday and Thursday afternoon, and on the first and third Fridays of the month in which an average of 20-30 patients are seen at each session. Besides offering care and follow up of ACHD patients, NHCS also does screening of suspected Marfan patients; close monitoring of ACHD patients during pregnancy (see Pregnancy and Women with CHD) and a monthly joint Cardiac Obstetric Clinic (every last Monday of the month) with obstetricians from Singapore General Hospital (SGH) ; Monthly Transition Clinic in KK Women's and Children's Hospital (KKH) run jointly with paediatric cardiologists from KKH for patients above the age of 16. The aim is to give paediatric patients a smooth transition from paediatric cardiology to adult cardiology services. An average of 100-150 teenagers with congenital heart disease are transferred from KKH to NHCS every year. There is also a monthly Pulmonary Hypertension Clinic (every second Friday of the month) run jointly with a respiratory physician and a rheumatologist from SGH for general as well as congenital patients with severe pulmonary hypertension.
  • Dedicated twice weekly congenital echocardiography sessions. 
  • Dedicated weekly congenital cardiac catheterisation and intervention (particularly atrial septal defect (ASD), patent foramen ovale (PFO) and patent ductus arteriosus (PDA) device closure).
  • Surgical interventions including extra-cardiac Fontan procedures for uni-ventricular hearts, pulmonary homograft replacements for Tetralogy of Fallot patients with severe pulmonary regurgitation, Rastalli conduit for patients with pulmonary atresia.
  • Expertise in nuclear imaging, magnetic resonance imaging (MRI) and multi-slice computed tomography (CT) imaging.
  • Expertise in pacing, arrhythmia treatment and ablation in congenital patients.
  • Expertise in cardiopulmonary and exercise testing.
  • Expertise in heart and lung transplantation for selected patients with end-stage congenital heart disease.
  • Dedicated ACHD nurse for education, support and care of ACHD patient and their families.

Adult Congenital Heart Disease (ACHD) Clinic

This clinic looks after patients with operated as well as unoperated congenital heart conditions from age 16 onwards. Adults with congenital heart disease need regular monitoring and sometimes further surgical interventions. It also screens suspected Marfan patients and monitors ACHD patients closely during pregnancy.

For more information on NHCS Adult Congenital Heart Disease (ACHD) Programme, visit here.

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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