Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
Curr Opin Obstet Gynecol. 2009 Dec;21(6):508-13. doi: 10.1097/GCO.0b013e328332a762.
The past 15 years have seen a five-fold increase in the incidence of acquired heart disease as a cause of maternal mortality in the UK, and advances in the surgical correction of congenital heart disease have enabled many more women to survive childhood and present at the antenatal clinic. This review updates the reader on these important conditions.
The major increased incidence of acute myocardial infarction during pregnancy has been attributed to an increasing proportion of older women having babies (risk 30-fold greater for women over 40 years compared with women under 20 years of age). The obesity epidemic is associated with increases in diabetes and hypertension. Percutaneous coronary intervention with stenting is the treatment of choice. Although aortopathies, cardiomyopathy and valvular heart disease present continuing problems, improvements in the management of pulmonary vascular disease (in particular, the use of sildenafil) have reduced mortality from this condition. Prophylaxis against endocarditis has been abandoned except for the highest risk cases.
Cardiac disease in pregnancy is of growing importance both in terms of numbers of women affected and mortality. Improvements in care have occurred particularly in relation to ischaemic heart disease and pulmonary hypotension.
在过去的 15 年中，英国因后天性心脏病导致的产妇死亡率增加了五倍，先天性心脏病的外科治疗进展使更多的女性能够在儿童期幸存并出现在产前诊所。本综述更新了读者对这些重要疾病的认识。
怀孕期间急性心肌梗死发病率的显著增加归因于越来越多的老年妇女生育（与 20 岁以下的妇女相比，40 岁以上的妇女的风险增加 30 倍）。肥胖症的流行与糖尿病和高血压的增加有关。经皮冠状动脉介入术联合支架置入术是首选治疗方法。尽管大血管疾病、心肌病和瓣膜性心脏病仍然是持续存在的问题，但肺动脉高压疾病管理的改善（特别是西地那非的使用）降低了这种疾病的死亡率。除了高危病例外，已不再预防性使用抗生素预防心内膜炎。
妊娠合并心脏病无论是在受影响的妇女人数还是死亡率方面都变得越来越重要。在缺血性心脏病和肺动脉高压方面的护理已经取得了显著的进展。
