Postpartum death with maternal congenital heart disease.

CONGENITAL cardiac malformations are responsible for 3 to 10% of the instances of organic heart disease encountered in pregnant women and about 1% of all maternal deaths.14 Although most women with congenital heart disease pass through gestation without incident, a few develop alarming intrapartum or postpartum circulatory abnormalities which result in death.3' 5-8 These deaths are usually related to cardiac malformations which permit direct shunts between the systemic and pulmonary circulations. Most common are ventricular septal defect and patent ductus arteriosus.3 -9 The alarming cardiovascular events which precede death are often characterized by changes in cardiac murmurs and reversal of previous left-to-right shunts.4 9 These uncommon but dramatic events have been attributed to changes in systemic vascular resistance and decreased venous return which normally fol-