Question of the Week

Question :

Posted On : 14 Dec 2004

A 28 yr old woman, now 27weeks pregnant with fetus having complex cardiac anomalies {endocardial cushion defect , VSD ,PS,double outlet right ventricle}. She had past history of abortion twice ,first was medically induced , second was spontaneous both in later half of 2003. No other significant family or past history. What should be the management now?

Expert Answer :

No expert answer available.

Answer Discussion :

pramod madhukar kulk

This pregnancy-MTP in view of minimal chance of viable-acceptable baby after counseling of parents.
Detail chromosomal studies {relatively older mother} and screening for cong.infection.
amniocentesis-cvs,Triple test and early usg for next pregnancy.

20 years ago

pediatriconcall

Endocardial cusion defect with complex congenital heart disease { as mentioned - conotruncal anomalies - DORV Plus VSD Plus Plus PS} are usually associated in 60-70 Percent of cases with trisomy 21 and other chromosomal anomalies like di george . Also incidence of non cardiac associations are high -like dandy walker cyst, neural tube defects, omphalocoele etc.Hence amniocentesis for karyotyping and congenital malformation scan are also essential.

As the mother is already into 27 weeks of her pregnancy it may be little difficult- dangerous to attempt MTP at this stage.However they could consult their obstetrician for the same .If they wish to continue pregnancy periodic follow up would be required - as complete heart block and hydrops fetalis are common with these anomalies . Institutional delivery and a complete 2 D Echo evaluation of the newborn child would be required.

As regards to outcome after the child is born depends if the cardiac condition is isolated or associated with chromosomal anomalies. If isolated - ECD with DORV Plus PS Plus VSD can be operated at 6-9 months of age at good centres { Chennai, Kochi} with fairly good outcome.

Most essential of all for future is - parents karyotype{ before Next pregnancy} - fetus karyotype{ if abortion opted} - childs karyotype{ if pregnancy continued} be done with referral to geneticist for counselling and peripartum folic acid supplementation for the future.

20 years ago

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