Bao Z L, Zhang J
Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Fu Chan Ke Za Zhi. 2018 Sep 25;53(9):608-612. doi: 10.3760/cma.j.issn.0529-567x.2018.09.005.
To summarize and analyze the methods of termination of pregnancy in the first and second trimester of pregnancy with severe cardiovascular disease. A retrospective analysis of 27 cases of termination of pregnancy in the first and second trimester of pregnancy in Beijing Anzhen Hospital from January 1, 2016 to December 30, 2017. All of these pregnant women were pregnancy complicated with severe cardiovascular disease in grade Ⅴ pregnancy risk. (1) The age of 27 pregnant women was 22-40 years, gestational age was 6-27 weeks; cardiac function grade before induced labor was: 5 cases of grade Ⅱ, 15 cases of grade Ⅲ, 7 cases of grade Ⅳ. The cardiovascular diseases included ventricular septal defect in 9 cases, simple atrial septal defect in 3 cases, patent ductus arteriosus in 2 cases, tetralogy of Fallot in 2 cases, rheumatic valvular disease in 1 case,arrhythmia-paroxysmal atrial velocity in 2 cases, cardiomyopathy in 2 cases, hypertensive cardiopathy in 2 cases, primary pulmonary hypertension in 1 case, tissue disease complicated with pulmonary hypertension 1 case, hyperthyroid heart disease in 1 case, coronary heart disease in 1 case. Among them, 21 cases were complicated with pulmonary hypertension, and 5 cases with Eisenmenger syndrome. (2) Methods of termination of pregnancy: in 27 cases, eight cases of vacuum curettage, and 2 cases of forceps curettage under general anesthesia without intubation; rivanol intraamniotic induction of labor in 1 case; and hysterotomy delivery in 16 cases (11 cases were treated with continuous epidural anesthesia, 1 case was treated with combined spinal and epidural anesthesia, 4 cases were treated with spinal anesthesia) . (3) After termination of pregnancy, one patient with severe primary pulmonary hypertension at 19 weeks of gestation died on the 1st day postoperative. No significant changes in cardiac function were observed in other patients before and after termination of pregnancy, and all of them survived. In patients with severe cardiovascular disease, termination of pregnancy after pregnancy may result in maternal death even at the second trimester of pregnancy.It is strongly recommended that such patients undergo pre-pregnancy assessment and fertility counseling.If visiting doctor after pregnancy, we should organize a multidisciplinary consultation as soon as possible to assess the risk of continuing pregnancy and give medical advice. If the risk of pregnancy is high, we should terminate the pregnancy as early as possible, after making a suitable treatment plan. During termination of pregnancy, temporary or permanent contraception may be taken if the condition permits.
总结分析妊娠合并严重心血管疾病患者在妊娠早、中期终止妊娠的方法。回顾性分析2016年1月1日至2017年12月30日在北京安贞医院妊娠早、中期终止妊娠的27例患者。所有这些孕妇均为妊娠风险Ⅴ级的妊娠合并严重心血管疾病患者。（1）27例孕妇年龄22 - 40岁，孕周6 - 27周；引产术前心功能分级：Ⅱ级5例，Ⅲ级15例，Ⅳ级7例。心血管疾病包括室间隔缺损9例，单纯房间隔缺损3例，动脉导管未闭2例，法洛四联症2例，风湿性瓣膜病1例，心律失常 - 阵发性房速2例，心肌病2例，高血压性心脏病2例，原发性肺动脉高压1例，结缔组织病合并肺动脉高压1例，甲状腺功能亢进性心脏病1例，冠心病1例。其中21例合并肺动脉高压，5例合并艾森曼格综合征。（2）终止妊娠方法：27例中，8例行负压吸引刮宫术，2例在非插管全身麻醉下行钳刮术；1例行利凡诺羊膜腔内引产；16例行子宫下段剖宫产术（11例采用连续硬膜外麻醉，1例采用腰硬联合麻醉，4例采用腰麻）。（3）终止妊娠后，1例孕19周的严重原发性肺动脉高压患者术后第1天死亡。其他患者终止妊娠前后心功能无明显变化，均存活。对于患有严重心血管疾病的患者，妊娠后终止妊娠即使在妊娠中期也可能导致孕产妇死亡。强烈建议此类患者进行孕前评估和生育咨询。如果妊娠后就诊，应尽快组织多学科会诊，评估继续妊娠的风险并给予医学建议。如果妊娠风险高，应在制定合适的治疗方案后尽早终止妊娠。在终止妊娠期间，病情允许时可采取临时或永久性避孕措施。
