Torres-Gómez Luis Guillermo, Iñigo-Riesgo Carmen Armida, Espinoza-Ortegón María Angélica, Barba-Bustos Ana María, Marín-Solís Bertha, Gómez-Vargas Juan Rafael
Hospital de Gineco-Obstetricia, Unidad Médica de Alta Especialidad, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jal.
Ginecol Obstet Mex. 2010 Jun;78(6):309-15.
Tetralogy of Fallot is the most common cyanotic congenital cardiac lesions. Although pregnancy in patients with corrected tetralogy of Fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications.
To report our experience in monitoring and treatment of 16 pregnancies in 14 women with tetralogy of Fallot.
Prospective study performed in 16 pregnancies of 14 patients with tetralogy of Fallot, who attended the services of Cardiology and High Risk Pregnancy in the Hospital de Gineco-Obstetricia of the Centro Médico de Occidente (Mexico), from January 1997 to January 2010. Nine women had total surgical correction and five hadn't. All patients obtained complete study protocol and tests of fetal wellbeing.
Hemoglobin and hematocrit were significantly higher in the group without surgical correction; this group also had lower oxygen saturation and right ventricular enlargement. Of the 16 pregnancies, five were resolved vaginally, the other by cesarean section. The cyanotic mothers had premature termination of pregnancy, lower birth weight and Apgar slightly deteriorated. There were no maternal or neonatal deaths, neither cardiac malformation in newborns.
There are more risks for the binomial in patients with uncorrected tetralogy of Fallot and in those operated with significant residual lesions. A greater anatomical impact was significantly correlated with major hemoglobin and minor oxygen saturation, which are the most important risk factors for adverse fetal outcomes.
法洛四联症是最常见的青紫型先天性心脏病变。虽然矫正型法洛四联症患者怀孕通常结局良好，但可能会出现母体心血管并发症。
报告我们对14例法洛四联症女性患者的16次妊娠进行监测和治疗的经验。
对1997年1月至2010年1月在墨西哥西部医疗中心妇产科医院心脏病学和高危妊娠科室就诊的14例法洛四联症患者的16次妊娠进行前瞻性研究。9名女性接受了完全手术矫正，5名未接受。所有患者均获得了完整的研究方案和胎儿健康检查。
未接受手术矫正的组中血红蛋白和血细胞比容显著更高；该组的血氧饱和度也更低且右心室增大。16次妊娠中，5次经阴道分娩，其余经剖宫产。青紫型母亲妊娠提前终止，出生体重较低且阿氏评分略有恶化。没有母体或新生儿死亡，新生儿也没有心脏畸形。
未矫正的法洛四联症患者以及有明显残留病变的手术患者的母婴面临更多风险。更大的解剖学影响与较高的血红蛋白和较低的血氧饱和度显著相关，而这是不良胎儿结局的最重要风险因素。
