Intrapartum Management of Maternal Congenital Heart Disease

Purpose of ReviewThis review discusses the special considerations in the care of pregnant patients with congenital heart disease (CHD) to minimize obstetric risks and avoid cardiac complications.Recent FindingsMultidisciplinary team planning is a cornerstone in the care of patients with CHD in pregnancy. Most patients with CHD should have neuraxial anesthesia and laboratory monitoring during labor and delivery, but the need for pulse oximetry, telemetry, and invasive hemodynamic monitoring should be individualized based on patient risk. Additionally, most patients with CHD can safely have a vaginal delivery at 39-40 weeks without additional maternal morbidity. Cesarean delivery should be reserved for typical obstetric indications with some exceptions.SummaryWith thoughtful multidisciplinary team management, pregnancy and labor can be well tolerated in those with congenital heart disease. There are some congenital cardiac lesions that require invasive cardiac monitoring and/or consideration of delivery in a cardiac care unit.