Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 102

Any cardiovascular condition which could impact on the mother’s ability to increase cardiac output and tolerate intravascular volume expansion can lead to problems in pregnancy. Data from the ROPAC registry suggest that structural heart disease significantly increases maternal risk [4]. Therefore, all women with cardiovascular disease wishing to embark on pregnancy should receive preconception counseling [5]. Assisted reproduction techniques (ART) may add to risk in this patient population: superovulation increases the pro‐thrombotic state of pregnancy, which is particularly relevant to patients at risk of thrombotic complications, e.g. those with mechanical heart valves, certain types of congenital and inherited cardiac conditions etc. Ovarian hyperstimulation syndrome (OHSS) can lead to significant fluid shifts, which may not be tolerated by women with brittle cardiovascular disease, and single embryo transfer is preferable in any woman with cardiovascular disease undergoing fertility treatment.

According to the 2018 European Society of Gynecology (ESG) guidelines on management of cardiovascular disease in pregnancy, IVF is contraindicated in any women considered to be in WHO class IV, and those in class III and/or on anticoagulation are at high risk from superovulation so that alternative methods such as natural cycle IVF should be considered [6].