Collins R Thomas, Chang Di, Sandlin Adam, Goudie Anthony, Robbins James M
Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Pediatrics, The University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Arkansas Children's Research Institute, The University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Am J Cardiol. 2017 Apr 1;119(7):1106-1110. doi: 10.1016/j.amjcard.2016.12.015. Epub 2017 Feb 16.
Most patients with single ventricle (SV) congenital heart disease are expected to survive to adulthood. Women with SV are often counseled against pregnancy; however, data on pregnancies in these women are lacking. We sought to evaluate in-hospital outcomes of pregnancy in women with SV. We used nationally representative data from the 1998 to 2012 National Inpatient Sample to identify women ≥18 years of age admitted to the hospital with International Classification of Diseases-9th Revision codes for an intrauterine pregnancy and a diagnosis of hypoplastic left heart syndrome, tricuspid atresia, or common ventricle. A matched comparison group without a diagnosis of congenital heart disease or pulmonary hypertension was identified from the database. National estimates of hospitalizations were calculated. Length of stay, hospital charges, and complications were analyzed and compared between groups. Charge data were adjusted to 2012 dollars. There were 282 admissions of pregnant women with SV (69% with deliveries) and 1,405 admissions in the control group (88% with deliveries). Vaginal delivery was more common in SV (74% vs 71%, p <0.001). Length of stay (4.1 ± 0.91 vs 2.8 ± 0.18 days, p <0.001) and charges ($30,787 ± 8,109 vs $15,536 ± 1,006, p <0.0001) were higher in the SV group. Complications occurred in most SV admissions and were more common in the SV group than in the control group. No deaths occurred. Cardiovascular complications occurred in 25% of pregnancy-related hospitalizations, although in-hospital pregnancy-related death is rare. Vaginal delivery is common in these patients. These data suggest that pregnancy and vaginal delivery can be tolerated in women with SV, although the risk for a cardiovascular event is significantly higher than in the general population.
大多数单心室（SV）先天性心脏病患者有望存活至成年。患有SV的女性通常会被告知不要怀孕；然而，关于这些女性怀孕的数据却很缺乏。我们试图评估患有SV的女性怀孕后的住院结局。我们使用了1998年至2012年全国住院患者样本中的全国代表性数据，以识别年龄≥18岁、因国际疾病分类第九版编码诊断为宫内妊娠且患有左心发育不全综合征、三尖瓣闭锁或共同心室而入院的女性。从数据库中确定了一个未诊断为先天性心脏病或肺动脉高压的匹配对照组。计算了全国住院率估计值。分析并比较了两组的住院时间、住院费用和并发症情况。费用数据已调整为2012年的美元价值。患有SV的孕妇有282例入院（69%分娩），对照组有1405例入院（88%分娩）。SV组中阴道分娩更为常见（74%对71%，p<0.001）。SV组的住院时间（4.1±0.91天对2.8±0.18天，p<0.001）和费用（30787±8109美元对15536±1006美元，p<0.0001）更高。大多数SV入院患者都出现了并发症，且SV组比对照组更常见。未发生死亡。心血管并发症发生在25%的与妊娠相关的住院病例中，尽管与妊娠相关的住院死亡很少见。这些患者中阴道分娩很常见。这些数据表明，患有SV的女性可以耐受怀孕和阴道分娩，尽管发生心血管事件的风险明显高于普通人群。
