Cauldwell Matthew, Gatzoulis Michael, Steer Philip
Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK.
Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK.
Obstet Med. 2017 Jun;10(2):53-57. doi: 10.1177/1753495X16687905. Epub 2017 Feb 5.
Cardiac disease in pregnancy is a challenging clinical problem. The number of women pursuing pregnancy and the underlying complexity of their cardiac disease is increasing, such that heart disease is now the leading cause of maternal mortality in developed countries. Women with congenital heart disease make up the majority of these cases and although maternal mortality is infrequent, a good outcome is only achieved though meticulous multidisciplinary care, beginning with pre-pregnancy counselling. All women with congenital heart disease should be assessed and be referred for pre-conception counselling prior to pregnancy and should receive thorough clinical assessment prior to pregnancy. In some conditions, such as pulmonary hypertension or severe/progressive aortic dilatation, pregnancy is of very high risk and women should be made aware of such risks. In such circumstances, if women choose to proceed with pregnancy, it is paramount that they are cared for by multidisciplinary teams who have experience and expertise of managing such conditions to minimise risks and optimise outcome.
妊娠期心脏病是一个具有挑战性的临床问题。寻求妊娠的女性数量及其心脏病的潜在复杂性不断增加，以至于心脏病现已成为发达国家孕产妇死亡的主要原因。先天性心脏病女性占这些病例的大多数，尽管孕产妇死亡率不高，但只有通过从孕前咨询开始的精心多学科护理才能取得良好的结果。所有患有先天性心脏病的女性在怀孕前都应接受评估并转诊进行孕前咨询，并且在怀孕前应接受全面的临床评估。在某些情况下，如肺动脉高压或严重/进行性主动脉扩张，怀孕风险非常高，应让女性了解此类风险。在这种情况下，如果女性选择继续妊娠，至关重要的是由具有管理此类疾病经验和专业知识的多学科团队对她们进行护理，以将风险降至最低并优化结局。
