Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2026

Pregnancy Outcomes in Women with Fontan Circulation Managed at a Tertiary Obstetric Centre in Western Australia: A 10-Year Retrospective Audit (#124)

Deirbhile McGahern 1 , Shin Lee 1 2 , Kelly O'Donovan 1 , Jelena Saundankar 2 3 , Faith Njue 2
  1. King Edward Memorial Hospital, Perth, WA
  2. Fiona Stanley Hospital, Perth, WA
  3. Perth Children's Hospital, Perth, WA

Background

Advances in cardiac surgery have resulted in increasing numbers of women with Fontan circulation reaching reproductive age. Pregnancy remains high risk in this patient cohort due to limited cardiovascular reserve and the inability of the Fontan circulation to accommodate the haemodynamic demands of gestation 1,2. Studies report maternal cardiac events in 19%, postpartum haemorrhage in 23%, and high rates of preterm birth and fetal growth restriction ¹,³. This audit evaluated maternal and perinatal outcomes in women with Fontan circulation managed at King Edward Memorial Hospital (KEMH).

Methods

A retrospective audit was undertaken of all pregnancies in women with Fontan circulation managed at KEMH between January 2016 and March 2026. Maternal cardiac, obstetric and neonatal outcomes were collected from electronic and paper medical records and analysed.

Results

Ten pregnancies were identified. Mean maternal age was 32.6 years. Maternal complications occurred in 4 pregnancies, including end-organ dysfunction (n=3) and heart failure (n=1). Venous thromboembolism occurred in 3 patients, with no cases of new-onset cyanosis. Postpartum ICU admission was required in 3 patients. There were no maternal deaths.

Obstetric and neonatal morbidity was significant. Postpartum haemorrhage occurred in 7 patients, preterm birth 5  (median gestation 35+6 weeks), fetal growth restriction in 4, miscarriage in 2, and nil recorded stillbirths.

Conclusions

Pregnancy in women with Fontan circulation is associated with substantial maternal and neonatal morbidity, particularly postpartum haemorrhage, preterm birth, and fetal growth restriction. Maternal survival was excellent in this cohort. These findings provide contemporary local data for counselling and service planning.

  1. 1. Breviario S, Krishnathasan K, Dimopoulos K, et al. Pregnancy in women with a Fontan circulation: short and long-term outcomes. Int J Cardiol. 2024;415:132445.
  2. 2. Montanaro C, Boyle S, Wander G, et al. Pregnancy in patients with the Fontan operation. Eur J Prev Cardiol. 2024;31(11):1336–1344.
  3. 3. Kim JA, Kim GB, Lee SY, Song MK, Bae EJ. Pregnancy outcomes in women with Fontan circulation: single tertiary center experience. Korean Circ J. 2025;55(9):828–837.