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Despite successful pregnancies post-cardiac transplantation, data are limited. Cardiac medication before pregnancy 42 , Hysteroscopy and laparoscopy can be life-threatening procedures in women with some forms of heart disease PH and Fontan , and should be undertaken in an experienced centre with appropriate support. Sodium nitroprusside should only be used as the drug of last choice since prolonged treatment is associated with an increased risk of foetal cyanide poisoning. Methyldopa should be avoided because of the risk of post-partum depression. If the woman is taking beta-blockers during pregnancy, they should be continued in the peripartum period.
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Pregnancy-induced changes in pharmacokinetics: For women at low-risk, therapeutic LMWH can be omitted for 24 h prior to anticipated delivery. Maternal BP and heart rate should be monitored in all patients with cardiac disease. It is often associated with foetal growth restriction due to placental insufficiency and is a common cause of prematurity. Inadequate human data use only when benefit outweighs risk. In women with unrepaired CoA and those repaired who have systemic hypertension, residual CoA or aortic aneurysms have an increased risk of complications including dissection. Stanford type A aortic dissection occurring during pregnancy is a surgical emergency.
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