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Abstract
Recent improvements in medical care have enabled women with cystic fibrosis (CF) to achieve a greater life expectancy and aspire to a greater expectation from life. Literature reporting pregnancy outcome in women with CF is sparse and focuses on women with mild disease. There remains a legacy of advising women with significant disease (FEV1<60%) to avoid pregnancy.
Pregnancy data was reviewed from all women with CF receiving care at a tertiary centre between 2003–2011. Input into hospital antenatal care was provided by a CF respiratory physician, an obstetrician in maternal medicine, a CF dietician, a CF physiotherapist and an obstetric anaesthetist. Individualised multidisciplinary plans were made for antenatal, delivery and postpartum care in all women. CF was managed aggressively with optimisation of nutrition, prompt treatment of infection and inpatient admission if necessary.
Results A total of 14 pregnancies in 12 women were identified. Mean age of pregnancy was 29.5(26–36). FEV1 at booking ranged from 27–80% (mean=62.8%). Diabetes was present in 9/14 women(three pre-pregnancy). The average gestation at delivery was 37+3(30–41). Vaginal delivery was advised in all cases (no obstetric contraindication), with elective epidural, oxygen support and passive management of the second stage. There was a 100% vaginal delivery rate (11 spontaneous vertex, 2 ventouse, 1 forceps). Average birth weight was 2.97 kg (2.2–3.83 kg). There were no postpartum complications.
Conclusion With careful multidisciplinary management, successful outcomes with vaginal deliveries have been obtained in this small series of women with CF, with a mean FEV1 of just over 60%.