Suwanrath Chitkasaem, Thongphanang Putthaporn, Pinjaroen Sutham, Suwanugsorn Saranyou
Department of Obstetrics and Gynecology.
Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Int J Womens Health. 2018 Jan 18;10:47-53. doi: 10.2147/IJWH.S150767. eCollection 2018.
To validate the modified World Health Organization (WHO) classification in pregnant women with congenital and acquired heart diseases.
The database of pregnant women with heart disease, who delivered at Songklanagarind Hospital between January 1995 and December 2016, was retrieved from the Statistical Unit, Department of Obstetrics and Gynecology, along with the Hospital Information System of Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University. Each patient was retrospectively classified according to the modified WHO classification of maternal cardiovascular risk. Comparison of maternal and fetal outcomes among the modified WHO classes were analyzed using the chi-square test or Fisher's exact test and one-way ANOVA test. A -value of <0.05 was considered statistically significant.
A total of 331 cases were studied: 157 cases with congenital heart disease and 174 cases with acquired heart disease. There were 48, 173, 32 and 78 cases in the modified WHO class I, II, III and IV, respectively. Congestive heart failure was the most common complication. The overall maternal mortality rate was 3.6%, all of which were in the modified WHO class IV. Maternal cardiovascular events occurred in 24.2% of cases, increasing rates with higher modified WHO class: 4.2%, 15.0%, 25.0% and 56.4% in class I, II, III and IV, respectively (<0.001). Adverse fetal outcomes including preterm delivery, low birth weight, small for gestational age and neonatal intensive care unit admission were also significantly increased in class III and IV (<0.05).
The modified WHO classification is useful not only for obtaining a cardiovascular risk assessment in pregnant women with heart disease but also for predicting adverse fetal outcomes. It must, therefore, be implemented into routine care service at all levels of health care systems.
验证改良世界卫生组织（WHO）分类法在患有先天性和后天性心脏病的孕妇中的有效性。
从宋卡王子大学医学院宋卡那加拉医院妇产科统计室及医院信息系统中检索1995年1月至2016年12月在宋卡那加拉医院分娩的心脏病孕妇数据库。根据改良的WHO孕产妇心血管风险分类法对每位患者进行回顾性分类。采用卡方检验、Fisher精确检验和单因素方差分析对改良WHO分类组间的孕产妇和胎儿结局进行比较。P值<0.05被认为具有统计学意义。
共研究331例病例：157例先天性心脏病，174例后天性心脏病。改良WHO分类法I、II、III和IV级分别有48、173、32和78例。充血性心力衰竭是最常见的并发症。孕产妇总死亡率为3.6%，均发生在改良WHO分类法IV级。24.2%的病例发生了孕产妇心血管事件，改良WHO分级越高发生率越高：I、II、III和IV级分别为4.2%、15.0%、25.0%和56.4%（P<0.001）。III级和IV级中包括早产、低出生体重、小于胎龄儿和新生儿重症监护病房收治在内的不良胎儿结局也显著增加（P<0.05）。
改良的WHO分类法不仅有助于对患有心脏病的孕妇进行心血管风险评估，还可预测不良胎儿结局。因此，必须将其应用于各级卫生保健系统的常规护理服务中。
