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    Fetal Outcome With Women CHD

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    Fetal Outcome With Women CHD

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    pjtcathlab
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    fetal outcome with women CHD

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    fetal outcome with women CHD

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    © All Rights Reserved
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    10 views19 pages

    Fetal Outcome With Women CHD

    Uploaded by

    pjtcathlab
    fetal outcome with women CHD

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 19

    Multidisciplinary Team

    Approach for optimal maternal


    and fetal Outcomes in Pregnant
    Women with CHD

    Adhi Pribadi
    Obstetrics & Gynecology Department Padjadjaran University-Hasan sadikin General Hospital
    Maternal-fetal division
    HOW'S MY
    NO
    BABY? ABNORMALITIES?

    IS THE
    PHYSICAL IS THE BABY
    NORMAL? PERFECT?

    MOTHER'S
    QUESTION TO
    THE DOCTOR?2
    The Goal : to evaluate
    •Cardiac Anatomy
    •Ventricular Function
    •Fetal Hemodynamics
    • Therapy Intervention???
    The Goal : to established
    Prognosis

    Obstetricians/Fetomaternalist
    Anatomi Concept in Fetal
    Echocardiography
    Effect CHD
    Short-term
    • No Survival
    • Growth and development

    Long Term
    • Growth & Development
    • Autism, Mental Retardation, Cerebral Palsy?
    • IQ
    Brain Development

    “The fetal brain is still very easy to


    form and for its formation requires
    optimal support from its
    environment to develop well”

    6
    MILD
    1. ASD
    2. VSD
    3. isolated semilunar valve
    disease

    “Low incidence of Disabilities Disorders”

    7
    MODERATE
    1. Coarctation of the aorta
    2. Complex semilunar valve
    disease
    3. AVSD
    4. VSD with comorbidities
    5. Tetralogy of Fallot,
    6. TAPV (Total anomalous
    pulmonary venous
    connection)

    “Increasing of Disabilities Disorders”

    8
    SEVERE/PALLIATED
    NEONATE
    1. Transposition of the
    great arteries
    2. Truncus arteriosus
    3. Interrupted aortic arch
    4. Tetralogy of
    Fallot/pulmonary atresia
    with major
    aortopulmonary
    collateral arteries
    5. Pulmonary atresia with
    intact ventricular septum
    6. Hypoplastic left heart
    syndrome
    7. Tricuspid atresia

    9
    Syndromic
    1. Down syndrome
    2. 22q11 deletion
    3. Noonan syndrome
    4. Williams syndrome
    5. Multiple congenital
    anomalies

    “nearly always associated with Disabilities Disorders”

    10
    • Cardiac Anatomi
    Normal Ventricular Septal Defect

    - Can to fix?
    - Can Survive?
    - Postpartum life?
    • Cardiac Anatomi
    Normal Atrioventricular Septal Defect

    - Can to fix?
    - Can Survive?
    - Postpartum life?
    1.Anatomi Antenatal=Postpartum
    Ultrasound Obstet Gynecol 2013; 41: 348–359

    Fetalechocardiography 2.Rhythm 97,5% Normal postpartum


    2-3% Persistent
    (Irregular)
    Influences:
    • Dustus Arteriosus
    “Real function 3.Ventricle Function • Foramen Ovale
    • Ductus Venosus
    after all • Morphometric function
    closed” • Short Fraction
    INDICATION
    FETALECHOCARDIOGRAPHY • Asymetric Chamber
    • Irregularity FHR
    • DM
    • Autoimmune
    Maternal Heart
    Factors Abnormal Routine Scan:
    -Polyhydramnios
    -Multiple Pregnancy
    -Wide NT
    Aneuploidy
    Family -Fetal Hydrops
    History Congenital
    Anomaly
    • Maternal Factor
    • Paternal Factor
    • History Family Heart • Trisomy
    Anomaly • Congenital Anomaly on
    Routine Scan
    PROGNOSIS
    Normal score:
    10 points
    Poor prognosis:
    < 5 points
    Ethical Issues
    • Parental counseling should be conducted as close as possible after a first
    suspicion of fetal CHD. (Obstetricians/Fetomaternalist)

    • This has to be conducted by a specialist with significant experience in fetal


    hemodynamics, potential in-utero progression of CHD.(FM)

    • Immediate postnatal treatment, long-term aspects and potential sequelae


    ideally up to the young adult age.(Cardiologist)

    • Parental counseling for fetal CHD is a particular sensitive area where only
    experienced specialists should conduct at least the first conversations
    with the parents.(FM-----Cardiologist)
    Councelling : Obstetrician/Fetomaternalist
    • It is very important not to impose personal bias into the
    discussion.
    • The goal of an optimal counseling session —or multiple
    sessions—is that parents make an informed choice, which is
    best for them and their family.
    • The decision-making here is often affected by social, cultural
    and religious backgrounds.
    Workshop
    Multidisclinary
    Approach

    RESUME

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