Grand A
Service de Cardiologie, Centre hospitalier de Valence.
Ann Cardiol Angeiol (Paris). 1992 Dec;41(10):549-64.
Any treatment used in pregnant women must take into account the effects of the substance in question of the fetus and the particular sensitivity of the latter during the first three months of development. The majority of drugs used in cardiology can be prescribed during pregnancy: digitalis preparations, furosemide, certain beta-blockers, verapamil, nifedipine (except during the first three months), quinidine, disopyramide, lignocaine, flecainide, amiodarone, heparins (non-fragmented and low molecular weight), central antihypertensive agents, dipyridamole and aspirin. In contrast, some drugs should be avoided because of insufficient information regarding their maternal and fetal consequences (bumetamide, modamide, the most recent beta-blockers, cibenzoline, ticlopidine) or because of harmful adverse effects on the fetus (spironolactones, bipyridines, diltiazem) or the newborn infant (angiotensin converting enzyme inhibitors). Finally, with certain medications (propafenone, oral anticoagulants), it is important to be able to compare maternal risks due to the disease and fetal risks induced by the drug. Modification of the conditions of use of these drugs and very careful monitoring of the patient most often suffice to avoid untoward events or complications with potentially serious medicolegal consequences and which may implicate the liability of the prescriber.
孕妇使用的任何治疗方法都必须考虑到相关物质对胎儿的影响以及胎儿在发育头三个月的特殊敏感性。心脏病学中使用的大多数药物在孕期都可以开具处方：洋地黄制剂、呋塞米、某些β受体阻滞剂、维拉帕米、硝苯地平（头三个月除外）、奎尼丁、丙吡胺、利多卡因、氟卡尼、胺碘酮、肝素（普通肝素和低分子肝素）、中枢性抗高血压药、双嘧达莫和阿司匹林。相比之下，一些药物应避免使用，原因是关于其对母体和胎儿影响的信息不足（布美他尼、莫达米德、最新的β受体阻滞剂、西苯唑啉、噻氯匹定），或者是因为对胎儿（螺内酯、联吡啶、地尔硫䓬）或新生儿有有害的不良反应（血管紧张素转换酶抑制剂）。最后，对于某些药物（普罗帕酮、口服抗凝剂），重要的是能够比较疾病导致的母体风险和药物引起的胎儿风险。改变这些药物的使用条件并对患者进行非常仔细的监测通常足以避免可能产生严重法律后果且可能涉及开处方者责任的不良事件或并发症。
