Fontan physiology: No sub-pulmonary ventricle, relies on non-cardiac forces for pulmonary blood flow to provide preload to the systemic ventricle

Low cardiac output and systemic venous hypertension.

Obstetric patients with Fontan physiology have an increased risk of pregnancy complications

Elevated systemic venous pressure and chronically decreased cardiac output impairs obstetric outcomes

Limited literature due to rarity

 26yo G1P0  with a h/o double inlet left ventricle status post Fontan procedure in infancy

Vaginal delivery: gradual hemodynamic changes, better tolerated in the context of the limited preload reserve and inability to augment cardiac output that characterize Fontan physiology.

Cesarean delivery is reserved for standard obstetric indications or for patients at risk of maternal decompensation, such as acute heart failure, refractory arrhythmias, or the need for coordinated cardiovascular interventions.

Neuraxial analgesia is strongly recommended for labor as it provides effective pain control, reduces catecholamine surges, and allows for rapid conversion to surgical anesthesia if emergent cesarean delivery is required.

Maintaining preload and avoiding increases in pulmonary vascular resistance are critical in Fontan patients. Excessive fluid administration can precipitate heart failure and pulmonary edema.

Multidisciplinary planning with obstetric, cardiology, and anesthesiology teams is critical for the care of these patients.