Department of Obstetrics and Gynecology, Renji Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Obstetrical Cardiology Intensive Care Center, Shanghai 200127, China.
Chin Med J (Engl). 2010 Sep;123(17):2324-30.
As the Shanghai Obstetrical Cardiology Intensive Care Center, our hospital has accumulated a large number of clinical data of pregnant women with heart disease. This paper is a retrospective analysis of 1142 pregnancies in women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.
A retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.
In this study, main heart diseases in pregnancy were arrhythmia (n = 359, 31.4%), congenital heart disease (CHD; n = 291, 25.5%), and myocarditis and its sequelae (n = 284, 24.9%); based on the functional classification criteria of New York Heart Association (NYHA), more than half (n = 678, 59.4%) of patients were classified NYHA Class I; pregnant women in NHYA Class I-II (n = 951, 83.3%) commonly had arrhythmia, myocarditis and its sequelae, while those in NHYA Class III-IV (n = 191, 16.7%) mainly had CHD, rheumatic heart disease (RHD), cardiopathy induced by hypertensive disorders complicating pregnancy, and peripartum cardiomyopathy (PPCM). Cardiac failure occurred in 97 (8.5%) patients, and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study. Compared with those in NHYA Class I-II, women in NHYA Class III-IV had a significantly lower gestational age at birth (P < 0.05), lower birth weight (P < 0.01), and higher incidence of preterm delivery, small for gestational age and perinatal death (P < 0.01). The incidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM was relatively high, with a rate of 80% and 52.2%, respectively. After cardiac operation, 131 (90.3%) women were in classified NHYA Class I-II and 14 (9.7%) in NHYA Class III-IV.
Arrhythmia is the type of heart disease that has a highest incidence in patients with heart disease in pregnancy, while main types of heart disease that impair cardiac function are CHD and RHD; cardiac failure is more frequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM; impaired cardiac function increases perinatal morbidity; cardiac surgery before pregnancy could improve the cardiac function.
作为上海妇产科心脏病重症监护中心，我院积累了大量患有心脏病的孕妇的临床资料。本文回顾性分析了 1993 年至 2007 年在我院分娩的 1142 例患有心脏病的孕妇的妊娠情况，以评估这些患者的母婴结局。
对 1993 年至 2007 年在上海妇产科心脏病重症监护中心分娩的 1142 例患有心脏病的孕妇进行回顾性分析。
本研究中，妊娠主要心脏病为心律失常（359 例，31.4%）、先天性心脏病（291 例，25.5%）和心肌炎及其后遗症（284 例，24.9%）；根据纽约心脏协会（NYHA）功能分类标准，超过一半（678 例，59.4%）患者为 NYHA I 级；NYHA I-II 级（951 例，83.3%）孕妇常见心律失常、心肌炎及其后遗症，而 NYHA III-IV 级（191 例，16.7%）孕妇主要患有先天性心脏病、风湿性心脏病（RHD）、妊娠高血压疾病引起的心脏病和围生期心肌病（PPCM）。本研究中发生心脏衰竭 97 例（8.5%），母亲死亡 8 例（0.7%），围产儿死亡 12 例（1.1%）。与 NYHA I-II 级患者相比，NYHA III-IV 级患者的出生胎龄（P<0.05）和出生体重（P<0.01）明显较低，早产、小于胎龄儿和围产儿死亡的发生率较高（P<0.01）。妊娠高血压疾病引起的心脏病和 PPCM 孕妇心脏衰竭的发生率相对较高，分别为 80%和 52.2%。心脏手术后，131 例（90.3%）患者 NYHA 分级为 I-II 级，14 例（9.7%）患者 NYHA 分级为 III-IV 级。
心律失常是妊娠合并心脏病患者中发病率最高的心脏病类型，而导致心功能受损的主要心脏病类型为先天性心脏病和风湿性心脏病；心脏衰竭更常由妊娠高血压疾病引起的心脏病和 PPCM 引起；心功能受损增加围产儿发病率；妊娠前心脏手术可改善心功能。
