Care of Pregnant Women with Tetralogy of Fallot and Valvular Regurgitation: A report of two cases

Abstract

Heart disease in pregnancy is a high risk condition and ranks among the top five causes of maternal death in Thailand. Pregnancy and delivery can exacerbate underlying cardiac disease; mothers commonly develop congestive heart failure and suffer acute cardiac events such as myocardial infarction, which can lead to maternal death. Moreover, maternal heart disease adversely affects pregnancy outcomes, including intrauterine growth restriction, preterm delivery, neonatal asphyxia, and stillbirth.
This study aimed to present two case reports to illustrate the process of risk assessment and multidisciplinary, evidence based care planning, and to synthesize practice based lessons that can be used to develop care pathways for pregnant women with heart disease. First case involved cyanotic congenital heart disease, Tetralogy of Fallot (TOF); second case involved mitral and aortic regurgitation. Both conditions are pathophysiologically complex and carry a high risk of maternal and fetal death. The women were managed by a multidisciplinary team with risk stratification using the modified WHO risk classification for cardiovascular disease in pregnancy, close antenatal surveillance, complication management, appropriate timing and mode of delivery, and postpartum monitoring. Results show that the key elements of optimal care for pregnant women with heart disease include systematic risk assessment, individualized multidisciplinary care grounded in evidence, and continuity of care from preconception through antenatal, intrapartum, and postpartum periods to ensure the safety of both mother and baby.