Can a woman with a history of patent ductus arteriosus (PDA) with device closure and normal echocardiogram (echo) results give birth safely?

Can a Woman with Device-Closed PDA and Normal Echo Safely Give Birth?

Yes, a woman with a successfully closed PDA (device closure) and normal echocardiogram can safely proceed with pregnancy and childbirth, as she falls into the low-risk category for pregnancy with repaired congenital heart disease.

Risk Stratification

Women with successfully repaired congenital heart disease without residual defects are at low risk during pregnancy. 1 The key determining factors are:

• Normal ventricular function 1
• Good exercise tolerance 1
• Absence of residual shunts 1
• Normal pulmonary artery pressures 1

Since your patient has a normal echocardiogram post-device closure, she meets all these favorable criteria.

Specific Considerations for Closed PDA

Endocarditis Prophylaxis

• Antibiotic prophylaxis is NOT recommended for patients with completely repaired PDA without residual shunt 1
• This applies to both dental procedures and vaginal delivery 1

Follow-Up Requirements

• Patients with device-closed PDA should be evaluated to confirm no residual shunt and normal left heart dimensions before pregnancy 1
• If the echo is truly normal with complete closure, routine cardiology follow-up during pregnancy can be minimal (typically 1-2 visits) 1

Delivery Planning

Mode of Delivery

• Spontaneous vaginal delivery is appropriate and recommended for women with repaired congenital heart disease and no residual defects 1
• There is no cardiac indication for cesarean section in this scenario 1

Precautions During Labor

While the risk is low, standard precautions for any patient with a history of device closure include:

• Meticulous elimination of air bubbles in all IV lines to prevent paradoxical embolization (though risk is minimal with complete closure) 1
• Early ambulation after delivery to reduce thromboembolism risk 1
• Compression stockings may be considered if prolonged bed rest is anticipated 1

Contraindications That Do NOT Apply Here

The following high-risk conditions are NOT present in your patient and therefore do not apply:

• Unrepaired PDA with pulmonary hypertension (contraindication to pregnancy) 1
• Eisenmenger syndrome (absolute contraindication) 1
• Significant residual left-to-right shunt causing left heart volume overload 1

Obstetric Outcomes

Expected outcomes are excellent for women with completely repaired PDA:

• No increased cardiovascular risk compared to general population 1
• No increased risk of pre-eclampsia or fetal growth restriction (unlike unrepaired defects) 1
• Standard obstetric care without cardiac restrictions is appropriate 2

Practical Algorithm

If normal echo confirms:

1. Complete PDA closure (no residual shunt on color Doppler) → Proceed with pregnancy
2. Normal left ventricular size and function → Low-risk pregnancy
3. Normal pulmonary artery pressures → Vaginal delivery planned
4. Good functional capacity → No activity restrictions needed

She can safely give birth now.