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Organisation of care for pregnancy in patients with congenital heart disease
  1. Jolien W Roos-Hesselink1,
  2. Werner Budts2,
  3. Fiona Walker3,
  4. Julie F A De Backer4,
  5. Lorna Swan5,
  6. William Stones6,7,
  7. Peter Kranke8,9,
  8. Karen Sliwa-Hahnle10,11,
  9. Mark R Johnson12
  1. 1 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
  3. 3 Department of Cardiology, Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
  4. 4 Department of Cardiology, Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
  5. 5 Department of Cardiology, Royal Brompton Hospital, London, UK
  6. 6 Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
  7. 7 Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
  8. 8 Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Wuerzburg, Germany
  9. 9 Scientific Subcommittee on Obstetric Anaesthesiology, European Society of Anaesthesiology, Brussels, Belgium
  10. 10 Department of Medicine, Faculty of Health Sciences, SA MRC Cape Heart Centre, Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa
  11. 11 Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  12. 12 Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr Jolien W Roos-Hesselink, Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands; j.roos{at}


Improvements in surgery have resulted in more women with repaired congenital heart disease (CHD) surviving to adulthood. Women with CHD, who wish to embark on pregnancy require prepregnancy counselling. This consultation should cover several issues such as the long-term prognosis of the mother, fertility and miscarriage rates, recurrence risk of CHD in the baby, drug therapy during pregnancy, estimated maternal risk and outcome, expected fetal outcomes and plans for pregnancy. Prenatal genetic testing is available for those patients with an identified genetic defect using pregestational diagnosis or prenatal diagnosis chorionic villus sampling or amniocentesis. Centralisation of care is needed for high-risk patients. Finally, currently there are no recommendations addressing the issue of the delivery. It is crucial that a dedicated plan for delivery should be available for all cardiac patients. The maternal mortality in low-income to middle-income countries is 14 times higher than in high-income countries and needs additional aspects and dedicated care.

  • Congenital heart disease

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  • Contributors All authors have made significant contributions to the design and writing of this study and will share responsibility for published material. All the authors have read, revised and approved the manuscript and gave consent to their names on the manuscript. None of the authors have a relationship with the industry.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online the affiliations for Dr William Stones have been corrected.