Miao H X, Feng S H, Wang C, Chen Y Y, Zhou Q, Lin J H
Department of Obstetrics and Gynecology, Affiliated Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Dec 25;54(12):826-832. doi: 10.3760/cma.j.issn.0529-567x.2019.12.006.
To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.
分析患有心血管疾病（CVD）的孕产妇死亡中的危险因素、心血管并发症、死亡时间、分娩孕周及子代结局。收集了上海产科心脏病重症监护病房26年（1993年1月至2018年12月）内共4112例患有CVD的孕妇病例，并对其中20例孕产妇死亡病例进行回顾性分析。（1）在这20例死亡病例中，结构性心脏病占90%（18/20），妊娠合并心脏病占10%（2/20），无功能性心脏病。患有CVD的孕妇死亡率为0.486%（20/4112）。（2）这些女性中常见的危险因素如下：未接受咨询怀孕（95%，19/20）、纽约心脏协会心功能Ⅲ或Ⅳ级（70%，14/20）、合并肺动脉高压（75%，15/20）及既往心脏事件（60%，12/20）。85%（17/20）的死亡发生在产褥期，15%（3/20）发生在分娩前，分娩期间无死亡病例。65%（13/20）的死亡死于心力衰竭，20%（4/20）的死亡归因于肺动脉高压危象，5%（1/20）分别死于心脏骤停、主动脉夹层破裂及猝死。患有CVD的女性应在严格评估后再怀孕。肺动脉高压是妊娠最严重的禁忌证之一，尤其是中重度肺动脉高压患者。产褥期是威胁这些患者安全的关键时期。由于心力衰竭是最常见的死亡原因，因此有必要预防和治疗心力衰竭，并动态监测心功能，尤其是那些有结构性心脏异常疾病的患者。此外，规范产前检查并及时识别心脏病的严重程度也很重要。
