Successful outcome of pregnancy in uncorrected tetralogy of fallot

Abstract

Tetralogy Of Fallot (TOF) is the most common cyanotic congenital heart disease. Most commonly, it is detected in the first year of life and it is rare for patients with the disease to reach adulthood without corrective surgery. Pregnancy in patients with uncorrected TOF is rare and is associated with high morbidity and mortality rates. This is due to increased maternal hypoxemia and cyanosis because of fall in systemic vascular resistance and rise in cardiac output which exacerbates the right to left shunt. Its management poses a challenge to the clinician because of the rarity of its occurrence and the paucity of literature. 22 year old woman, G₃A₂ with uncorrected TOF presented at 36 weeks gestation to the emergency room with breathlessness on routine daily activities (NYHA III) and severe fetal growth restriction. The patient had higher hemoglobin and hematocrit levels and lower platelet count. Oxygen saturation was low. Pregnancy was terminated by caesarean section under spinal anesthesia. Post caesarean patient had a febrile course and falling oxygen saturation (nadir 45.4%) which was intensively managed in consultation with cardiologist and physicians. She was discharged along with her baby in satisfactory condition on post-operative day twelve. Uncorrected TOF in pregnancy poses a therapeutic dilemma to the obstetrician, cardiologist and anesthetist.  Intensive multidisciplinary management is essential to optimize the fetomaternal prognosis. With adequate care, good outcome can be achieved.