Chassard D, Verspyck E
Département d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France.
Clinique gynécologique et obstétricale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Gynecol Obstet Fertil Senol. 2017 Dec;45(12S):S61-S64. doi: 10.1016/j.gofs.2017.10.019. Epub 2017 Nov 11.
Between 2010 and 2012, 29 maternal deaths were caused by cardiovascular disease, i.e. an overall maternal mortality ratio of 1.2 per 100,000 live births. Deaths occurred in pre-existing heart disease (n=19), peripartum cardiomyopathy (n=5), or arterial rupture (n=5). Care was considered non-optimal in three of five patients with congenital heart disease and due to delayed management by specialized teams. Pregnant patients with heart disease should be considered to be at high risk of mortality or severe cardiovascular complications and therefore reoriented as soon as possible to a perinatal center with the expertise of these pathologies. A delay in the management related to incorrect diagnosis was reported in three patients with peripartum cardiomyopathy. Peripartum cardiomyopathy should be considered in patients with severe left ventricular failure on cardiac ultrasound and particularly in women without pre-existing cardiac disease. A diagnosis of myocardial infarction was never suspected despite suggestive clinical and paraclinical criteria. A suggestive symptomatology of myocardial infarction reported in any pregnant woman and during the immediate postpartum period, and regardless of cardiovascular risk factors, should be promptly investigated and managed.
2010年至2012年间，29例孕产妇死亡由心血管疾病所致，即孕产妇总体死亡率为每10万例活产1.2例。死亡发生于原有心脏病（n = 19）、围产期心肌病（n = 5）或动脉破裂（n = 5）。5例先天性心脏病患者中有3例的治疗被认为不理想，原因是专科团队管理延迟。患有心脏病的孕妇应被视为有高死亡风险或严重心血管并发症风险，因此应尽快转诊至具备这些疾病专业知识的围产期中心。3例围产期心肌病患者报告了与诊断错误相关的管理延迟。心脏超声显示严重左心室衰竭的患者，尤其是无原有心脏病的女性，应考虑围产期心肌病。尽管有提示性的临床和辅助检查标准，但从未怀疑过心肌梗死的诊断。任何孕妇及产后即刻出现提示心肌梗死的症状，无论有无心血管危险因素，均应迅速进行检查和处理。
