Table 2.
Position and consensus statements on pregnancy in women with Turner syndrome
| Organization |
Contraindication to
pregnancy |
Pre-conception | ART | Monitoring during gestation | Delivery |
|---|---|---|---|---|---|
| American Society for Reproductive Medicine, 2012 (36) |
Pregnancy is absolutely contraindicated if any cardiac defects on MRI, including ASI>2 cm/m2 Pregnancy is relatively contraindicated, even if no cardiovascular defects |
Maternal counseling, including Cardiology and High-Risk OB Encourage other options for children Cardiac MRI |
Single embryo transfer |
Careful observation Periodic echocardiography or MRI Treat HTN Monitor for gestational diabetes, hypertension, hepatic failure |
ASI<2 cm/m2: OK for vaginal delivery ASI>2 cm/m2: C-section with epidural anesthesia before labor |
| French Joint Practice Committee, 2010 (46) |
Contraindicated if any past or current aortic disease, uncontrolled hypertension, or portal hypertension with esophageal varices Not contraindicated if isolated BAV |
Maternal counseling, including Cardiology, Endocrinology, and others Blood pressure Echocardiography Cardiac/aortic MRA |
Single embryo transfer |
Echocardiography at end of 1st and 2nd trimesters and monthly during 3rd trimester, confirm suspected aortic dilatation with MRI Treat HTN with beta blockade Echocardiography 5-8 days post- partum |
ASI<2.5 cm/m2: OK for assisted vaginal delivery ASI>2.5 cm/m2: Hospitalize, accelerate fetal lung maturity, C- section |
| Turner Syndrome Consensus Study Group, 2007 (2) |
Relatively contraindicated if: Surgically repaired cardiovascular disease, BAV, aortic dilatation, hypertension. Counsel against pregnancy if these conditions present |
Maternal counseling Echocardiography EKG Cardiac MRI |
Single embryo transfer |
Care by Cardiology and High-risk OB at a tertiary care facility Monitor for gestational diabetes, hypothyroidism, hypertension |
Vaginal delivery allowable under “optimal conditions” |
ART, Assisted reproductive technology; ASI, Aortic size index; BAV, Bicuspid aortic valve; C-section, Cesarean section; EKG, Electrocardiogram; HTN, Hypertension; MRA, Magnetic resonance angiography; MRI, Magnetic resonance imaging; OB, Obstetrics