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Heart, Lung and Circulation

Fertility and pregnancy in the Fontan population

      Aim: To describe the experience of a cohort of adult women with a Fontan circulation with respect to menarche, contraceptive use, pregnancy advice and outcomes.
      Methodology: Adult women enrolled in the ANZ Fontan Registry were approached to participate in a questionnaire study ascertaining details of their gynaecological and obstetric history.
      Results: During recruitment (Feb 2012 - July 2014) 147 women with a Fontan circulation (not lost to follow-up) were identified. Of these, 12 refused and 1 withdrew consent. Of the remaining 134 women, 99 consented and 97 completed the initial questionnaire. Women were aged 25 (23 – 32). Fontan operation type was: atriopulmonary (40%), lateral tunnel (50.5%), extracardiac [ECC](7.5%) and secondary ECC (1%). The largest single contraceptive ever used was the combined OCP. The commonest medical advice given, to 43% of women, was that pregnancy would be at increased risk. A total of 27 women reported pregnancy, 2 declined to give any further information. Of the remaining 25 women, all consented to a further questionnaire but this was only completed by 20. These 20 women reported 40 pregnancies, of which 42% (17) led to delivery. There were 17 liveborn babies, including 1 set of twins. One baby was stillborn. Median gestation at delivery was 31.5 (27.4 – 37) weeks and weight was 1350 (879 – 2520) gms. Two babies experienced a neonatal death in the setting of prematurity.
      Conclusion: Women with a Fontan circulation report appropriate medical advice regarding increased pregnancy risk. When successful, pregnancy is characterised by delivery of a premature small baby.