![]() ![]() The physiologic changes of pregnancy to the circulatory system include an increase in cardiac output by 30-50% and an increased blood volume by 40% by 28 weeks. Unscreened patients and patients with known but untreated pulmonary AVMs of significant size (>2-3 mm) are at highest risk. Risk stratification can be based upon the results of a patient’s AVM screening and/or treatment. However, it is possible to stratify this risk. Many pregnant women with HHT are labeled as “high-risk”, as there is 1% overall risk of complication in pregnancy in patients with HHT(103). The term “high-risk pregnancy” is a label used to describe situations in which a pregnant woman, her fetus, or both, are at higher risk when compared to a “typical” pregnancy for complications during pregnancy, labor & delivery or post-partum. In addition, given that offspring are at 50% risk of inheriting the pathogenic mutation, pre-pregnancy consultation with an obstetrician is recommended, for consideration of options before and during and after pregnancy for genetic diagnosis. At the initial obstetrical visit, pregnant patients should have a thorough review of their diagnosis history and past evaluations as well as recent status, symptoms and concerns. ![]() While concerns exist for the testing of asymptomatic children for adult onset conditions for which there is no potential benefit of testing in childhood, childhood AVM screening is recommended in HHT (see pediatric section), with treatment in selected cases,Ī pregnant woman with HHT should be assessed for their risk of pregnancy and delivery related complications and have access to, as needed, to a multidisciplinary maternal-fetal medicine team that includes HHT experts.
0 Comments
Leave a Reply. |