Department of Obstetrics, Leiden University Medical Centre, the Netherlands.
Department of Obstetrics, Leiden University Medical Centre, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:150-155. doi: 10.1016/j.ejogrb.2020.03.013. Epub 2020 Mar 6.
Maternal heart disease (HD) complicates 1-4 % of pregnancies and is associated with adverse maternal and fetal outcomes. Although vaginal birth is generally recommended in the guidelines, cesarean section (CS) rates in women with HD are often high. Aim of the present study was to evaluate mode of birth and pregnancy outcomes in women with HD in a tertiary care hospital in the Netherlands.
The study population consisted of 128 consecutive pregnancies in 99 women with HD, managed by a pregnancy heart team between 2012-2017 and ending in births after 24 weeks' gestation. Pregnancy risk was assessed per modified World Health Organization class. Mode of birth (planned and performed) and maternal and fetal complications (cardiovascular events, postpartum hemorrhage, prematurity, small for gestational age and death) were assessed for each pregnancy.
Pregnancy risk was classified as modified World Health Organization class I in 23 %, class II in 50 %, class III in 21 % and class IV in 6% of pregnancies. Planned mode of birth was vaginal in 114 pregnancies (89 %) and CS in 14 (11 %; nine for obstetric and five for cardiac indication). An unplanned CS was performed in 18 pregnancies (16 %; 16 for obstetric and two for cardiac indications). Overall mode of birth was vaginal in 75 % and CS in 25 %. Twelve cardiovascular events occurred in eight pregnancies (6 %), postpartum hemorrhage in nine (7 %) and small for gestational age in 14 (11 %). No maternal or fetal deaths occurred.
Findings of this study indicate that - given that pregnancies are managed and mode of birth is meticulously planned by a multidisciplinary pregnancy heart team - vaginal birth is a suitable option for women with HD.
母体心脏病（HD）在 1-4%的妊娠中并发，与母婴不良结局相关。尽管指南一般推荐阴道分娩，但患有 HD 的女性行剖宫产术（CS）的比率往往较高。本研究旨在评估荷兰一家三级保健医院中患有 HD 的女性的分娩方式和妊娠结局。
该研究人群由 99 名患有 HD 的女性的 128 例连续妊娠组成，这些妊娠由妊娠心脏团队在 2012-2017 年期间管理，最终分娩时间为 24 周后。妊娠风险按照世界卫生组织改良分类进行评估。对于每例妊娠，评估分娩方式（计划分娩和实际分娩）以及母婴并发症（心血管事件、产后出血、早产、小于胎龄儿和死亡）。
妊娠风险按照世界卫生组织改良分类，I 级 23%，II 级 50%，III 级 21%，IV 级 6%。计划分娩方式为阴道分娩 114 例（89%），CS 14 例（11%；9 例因产科原因，5 例因心脏原因）。18 例（16%；16 例因产科原因，2 例因心脏原因）行计划性 CS。总体分娩方式为阴道分娩 75%，CS 25%。8 例妊娠发生 12 例心血管事件（6%），9 例发生产后出血（7%），14 例发生小于胎龄儿（11%）。无母婴死亡。
本研究结果表明，在多学科妊娠心脏团队管理下精心计划分娩方式的前提下，阴道分娩是患有 HD 的女性的合适选择。
