45例合并先天性心脏病的肺动脉高压孕妇的围产期结局

Meng Yuan, Huang Yin-Ping, Liu Xiao-Li, Huang Yan-Jun, Zhou Jie, Xiong Chun-Qiu, Wu Li-Qun, Wang Bo, Cai Cai-Ping

Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.

Zhonghua Fu Chan Ke Za Zhi. 2007 Oct;42(10):662-5.

OBJECTIVE

To explore the perinatal outcomes of women with pulmonary hypertension complicating congenital heart disease (CHD).

METHODS

Clinical data of 45 cases of pregnant women with pulmonary hypertension complicating CHD from Apr 1995 to May 2007 were analyzed and they were divided into three groups: 29 cases of slight group [pulmonary hypertension of 30 mm Hg (1 mm Hg = 0.133 kPa) to 49 mm Hg], 8 cases of moderate group (pulmonary hypertension of 50 mm Hg to 79 mm Hg) and 8 cases of severe group (pulmonary hypertension equal to or higher than 80 mm Hg). The types of CHD, cardiac functional status (New York heart association, NYHA), gestational weeks of pregnancy termination, mode of delivery, pregnancy after CHD operation and outcomes of infants were compared between the groups.

RESULTS

(1) The highest incidence of CHD were atrial septal defect and ventricular septal defect (58%, 26/45). The rate of pregnant women after CHD operation was 29% (13/45), they were mainly in slight group and their NYHA class were in I - II. (2) The occurrence rate of NYHA class III - IV was 7 /8 in severe group. The rate of NYHA class I - II was 6/8 in moderate group. The rate of NYHA class I - II was 97% (28/29) in slight group. (3) The rate of term delivery was 93% (27/29), preterm labor 3% (1/29), abortion 3% (1/29), and the birth weight was (3153 +/- 399) g on average in slight group. The rate of term delivery was 5/8, preterm labor occurred in 3 cases in moderate group. The rate of term delivery was 5/8, preterm labor occurred in 2 cases, and iatrogenic abortion in 1 case in severe group. The average birth weight between slight group and moderate or severe group had a significant difference. (4) Caesarean section rate was 78% (35/45) among all patients. The rate of cesarean section delivery was 76% (22/29) in slight group, 6/8 in moderate group, and 7/8 in severe group. (5) The rate of pregnant women who had portent heart failure or heart failure was 24% (11/45), overall maternal mortality was 4% (2/45).

CONCLUSIONS

The higher the pulmonary hypertension, the worse the outcome of the mother and fetus; The pregnant women with good heart function after cardiac operation would have a good perinatal outcome. Cesarean section is more suitable for those women.

目的

探讨合并先天性心脏病（CHD）的肺动脉高压女性的围产期结局。

方法

分析1995年4月至2007年5月45例合并CHD的肺动脉高压孕妇的临床资料，将其分为三组：轻度组29例[肺动脉高压30 mmHg（1 mmHg = 0.133 kPa）至49 mmHg]，中度组8例（肺动脉高压50 mmHg至79 mmHg），重度组8例（肺动脉高压等于或高于80 mmHg）。比较三组患者的CHD类型、心功能状态（纽约心脏协会，NYHA）、终止妊娠孕周、分娩方式、CHD手术后妊娠情况及婴儿结局。

结果

（1）CHD发病率最高的是房间隔缺损和室间隔缺损（58%，26/45）。CHD手术后孕妇比例为29%（13/45），主要在轻度组，NYHA分级为Ⅰ-Ⅱ级。（2）重度组NYHAⅢ-Ⅳ级发生率为7/8。中度组NYHAⅠ-Ⅱ级发生率为6/8。轻度组NYHAⅠ-Ⅱ级发生率为97%（28/29）。（3）轻度组足月分娩率为93%（27/29），早产率3%（1/29），流产率3%（1/29），平均出生体重为（3153±399）g。中度组足月分娩率为5/8，早产3例。重度组足月分娩率为5/8，早产2例，医源性流产1例。轻度组与中度或重度组平均出生体重有显著差异。（4）所有患者剖宫产率为78%（35/45）。轻度组剖宫产分娩率为76%（22/29），中度组为6/8，重度组为7/8。（5）发生先兆心力衰竭或心力衰竭的孕妇比例为24%（11/45），孕产妇总死亡率为4%（2/45）。