Lin Jian-hua, Zhao Wei-xiu, Su Yu, Shi Jun, Jiang Guo-jing, Wu Zhen-ming
Department of Obsterics and Gynecology, Affiliated Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 Feb;41(2):99-102.
To evaluate the pregnancy outcome of women with pulmonary hypertension complicating cardiac disease.
Clinical data of 61 cases of pregnant women with pulmonary hypertension from Jan 1996 to Aug 2004 were analyzed and they were divided into three groups: 32 cases of slight group [pulmonary hypertension from 30 mm Hg (1 mm Hg = 0.133 kPa) to 49 mm Hg], 23 cases of moderate group (pulmonary hypertension from 50 mm Hg to 79 mm Hg) and 6 cases of severe group (pulmonary hypertension equal to or higher than 80 mm Hg). The types of heart disease, cardiac functional status (New York heart association, NYHA), gestational weeks of pregnancy termination, mode of delivery and outcomes of infants were compared between the groups.
(1) The occurrence rate of NYHA class III - IV was 5/6 in severe group. The rate of NYHA class I - II was 72% (23/32) in slight group. (2) The rate of moderate and severe pulmonary hypertension was 53% (11/21) and of NYHA class IV 43% (9/21) in rheumatic heart disease. The rate of slight pulmonary hypertension was 97% (35/36) and NYHA class I - II 81% (29/36) in congenital heart disease. (3) The rate of term delivery was 75% (24/32) and the birth weight was 2744 g on average in slight group. The rate of term delivery was 48% (11/23), preterm labor 35% (8/23), abortion 17% (4/23) in moderate group. The rate of term delivery was 1/6, preterm labor occurred in 3 cases, and abortion in 2 cases in severe group. The rates of neonatal complications between the three groups had no significant difference. (4) Caesarean section rate was 79% (48/61) among all patients. (5) Overall maternal mortality was 2% (1/61).
The rate of heart failure increases gradually with the severity of pulmonary hypertension. The severity of pulmonary hypertension in rheumatic heart disease is higher than in congenital heart disease. The rate of maternal mortality and fetal loss increases in pregnant women with pulmonary hypertension complicating cardiac disease. Perinatal morbidity is higher than normal. Cesarean section is more suitable for those women.
评估合并心脏病的肺动脉高压女性的妊娠结局。
分析1996年1月至2004年8月61例肺动脉高压孕妇的临床资料，将其分为三组：轻度组32例（肺动脉高压30mmHg（1mmHg = 0.133kPa）至49mmHg），中度组23例（肺动脉高压50mmHg至79mmHg），重度组6例（肺动脉高压等于或高于80mmHg）。比较各组心脏病类型、心功能状态（纽约心脏病协会，NYHA）、终止妊娠孕周、分娩方式及婴儿结局。
（1）重度组NYHAⅢ - Ⅳ级发生率为5/6。轻度组NYHAⅠ - Ⅱ级发生率为72%（23/32）。（2）风湿性心脏病中重度肺动脉高压发生率为53%（11/21），NYHAⅣ级为43%（9/21）。先天性心脏病中轻度肺动脉高压发生率为97%（35/36），NYHAⅠ - Ⅱ级为81%（29/36）。（3）轻度组足月分娩率为75%（24/32），平均出生体重2744g。中度组足月分娩率为48%（11/23），早产率35%（8/23），流产率17%（4/23）。重度组足月分娩率为1/6，早产3例，流产2例。三组新生儿并发症发生率无显著差异。（4）所有患者剖宫产率为79%（48/61）。（5）孕产妇总死亡率为2%（1/61）。
心力衰竭发生率随肺动脉高压严重程度逐渐增加。风湿性心脏病肺动脉高压严重程度高于先天性心脏病。合并心脏病的肺动脉高压孕妇孕产妇死亡率和胎儿丢失率增加。围产期发病率高于正常。剖宫产更适合这些女性。
