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30 Managing delivery in women with congenital heart disease: results from the cuban national programme for pregnancy and heart disease
  1. C Kinsella1,
  2. SA Thorne2,
  3. PF Clift2,
  4. LE Hudsmith2,
  5. S Bowater2,
  6. R Vasallo Peraza3,
  7. JE Perez Torga3,
  8. PA Roman Rubio3
  1. 1University of Birmingham, Birmingham, UK
  2. 2Queen Elizabeth Hospital, Birmingham, UK
  3. 3Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba


Purpose To provide an update on the delivery outcomes achieved in congenital heart disease (CHD) patients by the Cuban National Programme for Pregnancy and Heart Disease.

Methods This was a single-centre retrospective study on a prospectively collected database from 1 st January 2000 to 15th May 2017. Baseline data: demographics (age, province of origin), diagnosis, co-morbidities and functional status. Primary outcomes: duration of pregnancy, pregnancy outcome, any maternal or fetal complications.

Results Overall 467 pregnancies in 462 women reached the third trimester. Median age was 25 (21–29) years, with 71% of cases originating from Havana. Patients presented in NYHA class I (97%, n=453) or II (3%, n=14), 6% (n=27) of patients had arrhythmias, 1% (n=4) had significant co-morbidities, and 1% (n=4) had impaired left ventricular function. One pregnancy resulted in stillbirth, with the rest (n=466) resulting in live births (n=469) of median birth weight 3200 (2880–3420) grams. Median duration of gestation was 39 (38.6–40) weeks. Sixty-six percent (n=307) of patients had a vaginal delivery; caesarean section rates were 34% (n=161). Maternal cardiovascular complications (<0.5%, n=2), and obstetric complications (14%, n=67) did not result in mortality. Being small-for-gestational-age was the commonest complication (10%, n=48) in neonates, with zero mortality. Three neonates (1%) inherited congenital cardiac defects. Post-delivery NYHA functional status was class I in 84% (n=393) patients, class II in 16% (n=73) of patients and class III in one patient (<0.5%).

Conclusion Despite considerable resource constraints, in middle-income countries management of CHD pregnancies according to existing guidelines can achieve excellent outcomes.

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