Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Cardiol. 2013 Feb;61(2):107-12. doi: 10.1016/j.jjcc.2012.11.001. Epub 2013 Jan 3.
Although its prevalence is relatively low in pregnant women, heart disease is the most important cause of maternal mortality. Problems may arise due to hemodynamic burden and the hypercoagulable state of pregnancy. Heart disease may be congenital or acquired. In developed countries, the former composes the biggest part of women with heart disease. Patients with unrepaired lesions, cyanotic lesions, diminished systemic ventricular function, complex congenital heart disease, left ventricular outflow tract obstruction, pulmonary hypertension, or mechanical valves are at highest risk of developing complications during pregnancy. All patients with known cardiac disease should preferably be counseled before conception. Pre-pregnancy evaluation should include risk assessment for the mother and fetus, including medication use and information on heredity of the cardiac lesion. Management of pregnancy and delivery should be planned accordingly on individual bases. The types of complications are related to the cardiac diagnosis, with arrhythmias and heart failure being most common. Treatment options should be discussed with the future parents, as they may affect both mother and child. In general, the preferred route of delivery is vaginal. The optimal care for pregnant women with heart disease requires multidisciplinary involvement and is best concentrated in tertiary centers.
虽然心脏病在孕妇中的发病率相对较低，但它是孕产妇死亡的最重要原因。由于血流动力学负担和妊娠的高凝状态，可能会出现问题。心脏病可能是先天性的，也可能是后天获得的。在发达国家，前者构成了患有心脏病的女性的最大部分。未修复病变、发绀性病变、全身心室功能减退、复杂先天性心脏病、左心室流出道梗阻、肺动脉高压或机械瓣膜的患者在怀孕期间发生并发症的风险最高。所有患有已知心脏病的患者最好在受孕前接受咨询。孕前评估应包括对母亲和胎儿的风险评估，包括药物使用和心脏病变遗传信息。应根据个人情况相应地计划妊娠和分娩的管理。并发症的类型与心脏诊断有关，心律失常和心力衰竭最为常见。应与未来的父母讨论治疗选择，因为它们可能会同时影响母亲和孩子。一般来说，首选的分娩方式是阴道分娩。患有心脏病的孕妇的最佳护理需要多学科参与，最好集中在三级中心。
