Lima Fabio V, Koutrolou-Sotiropoulou Paraskevi, Parikh Puja B, Avila Cecilia, Butler Javed, Stergiopoulos Kathleen
a Department of Medicine , Brown University - Rhode Island Hospital , Providence , Rhode Island , USA.
b Division of Cardiovascular Medicine , Stony Brook University , Stony Brook , New York , USA.
Acute Card Care. 2016 Sep;18(3):56-64. doi: 10.1080/17482941.2017.1397699. Epub 2017 Nov 22.
Pregnant women with heart disease (HD) have higher rates of adverse fetal outcomes. We describe placental pathologic characteristics and their association with fetal events.
In pregnant women, known HD were categorized into: (1) cardiomyopathy (CM) or (2) other HD (congenital, coronary, arrhythmia, or valvular). Outcomes were maternal major adverse cardiac events (MACE), fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Only pathologically reported placental analyses were included.
We studied 86 pregnancies in women with CM and HD, with pathologic analyses on 35 CM and 52 HD placentas. CM placentas, compared with those with HD, were more likely to have ischemic changes (65.7% vs. 37%, p 0.008), demonstrate immaturity (62.90% vs. 10%, p < 0.001), and have a lower weight (p < 0.001), despite similar gestational age. CM was independently associated with increased risk for MACE (OR 7.38, 95%CI 2.20-24.76). Ischemic placental changes were associated with increased odds of FACE (OR 24.78, 95%CI 2.37-259.03).
Women with CM were more likely to have ischemic placentas, with lower placental and fetal weights, and evidence of immaturity compared with those with other forms of HD, and an increased odds of MACE.
患有心脏病（HD）的孕妇出现不良胎儿结局的发生率更高。我们描述了胎盘的病理特征及其与胎儿事件的关联。
在孕妇中，已知患有HD的被分为：（1）心肌病（CM）或（2）其他HD（先天性、冠状动脉性、心律失常性或瓣膜性）。结局指标为孕产妇主要不良心脏事件（MACE）、胎儿不良临床事件（FACE），后者是婴儿死亡、早产、低体重、颅内出血和呼吸窘迫的综合指标。仅纳入有病理报告的胎盘分析。
我们研究了86例患有CM和HD的孕妇的妊娠情况，对35例CM胎盘和52例HD胎盘进行了病理分析。与HD胎盘相比，CM胎盘更易出现缺血性改变（65.7%对37%，p = 0.008）、表现为不成熟（62.90%对10%，p < 0.001）且重量更低（p < 0.001），尽管孕周相似。CM与MACE风险增加独立相关（比值比[OR] 7.38，95%置信区间[CI] 2.20 - 24.76）。胎盘缺血性改变与FACE几率增加相关（OR 24.78，95%CI 2.37 - 259.03）。
与其他形式的HD患者相比，患有CM的女性更易出现缺血性胎盘，胎盘和胎儿重量更低，有不成熟的证据，且MACE几率增加。
