PREGNANCY AND COARCTATION OF THE AORTA

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Abstract
The pathological anatomy and physiology, and the clinical signs of coarctation of the aorta are reviewed together with the natural history of the disease and the prognosis apart from pregnancy. The literature on coarctation of the aorta and pregnancy is reviewed together with the writer''s personal experience. It is concluded that pregnancy does not add to the hazards of coarctation, and that there is no evidence that patients are more likely to develop dissection or rupture of the aorta or infection during pregnancy than at any other time. It is, however, noted that medial necrosis of the aorta may be associated with coarctation, and that an increased incidence of medial necrosis in pregnancy has been reported irrespective of coarctation. Ideally coarctation should be resected before the child-bearing era, but when pregnancy occurs in a patient with coarctation the pregnancy should be allowed to continue, but the patient kept under careful observation. There is no cause for delivery by caesarean section. When heart disease complicates coarctation the prognosis and management should be that of the heart disease rather than of the coarctation, and the patient may require termination early in pregnancy if the heart disease is sufficiently severe, or cardiac operation during pregnancy if the cardiac lesion warrants it. Most patients, however, with careful attention will manage pregnancy without incident.