Cardiopulmonary and Peripheral Vascular Function Unit, Cardio-obstetric Clinic, Hospital Universitario San Vicente Fundación, Colombia.
Department of Internal Medicine, Cardiology Section, Universidad de Antioquia, Antioquia, Colombia.
Arch Cardiol Mex. 2020;90(2):101-107. doi: 10.24875/ACME.M20000102.
Heart disease in pregnancy can cause clinical deterioration and maternal-fetal death. It is essential to evaluate risk factors related to complications.
This was a observational, analytical retrospective cohort study with a non-probabilistic convenience sample of pregnant women with congenital or acquired heart disease, corrected or not, or arrhythmias requiring urgent intervention. Patients with mild or moderate valvular regurgitation, mild valvular stenosis, patients without echocardiography or without delivery information were excluded from the study. The outcome was a composite of cardiac, obstetric, and neonatal events. Univariate and multivariate analyzes were performed with logistic regression model and discriminatory capacity with area under the curve and independent analysis of the modified World Health Organization (mWHO) risk classification (mWHO).
A total of 104 patients with an average age of 25 ± 6.5 years presented cardiac events in 13.5%, obstetric in 14.42%, and neonatal in 28.85%. The univariate analysis found an association with New York Heart Association functional status, hypertensive disorders of pregnancy, cesarean delivery, gestational age < 27 weeks, hypoxemia, and mWHO risk. In multivariate only cesarean delivery (odds ratio [OR], 2.68; 95% confidence interval [CI], 1.05-6.86) and gestational age at delivery (OR, 0.39; 95% CI, 0.22-0.67) maintain association with outcomes. The area under the curve for the mWHO risk is 0.75.
There is a high rate of adverse events in patients with heart disease during pregnancy. Gestational age and cesarean delivery behaved as predictors of adverse maternal-fetal outcomes. The mWHO risk classification had an acceptable prediction of adverse outcomes.
妊娠合并心脏病可导致临床恶化和母婴死亡。评估与并发症相关的危险因素至关重要。
这是一项观察性、分析性回顾性队列研究，采用先天性或获得性心脏病、经矫正或未经矫正的心律失常孕妇的非概率便利样本。排除轻度或中度瓣膜反流、轻度瓣膜狭窄、无超声心动图或无分娩信息的患者。研究的结局是心脏、产科和新生儿事件的综合结果。使用逻辑回归模型进行单变量和多变量分析，并使用曲线下面积和改良世界卫生组织（mWHO）风险分类（mWHO）的独立分析进行区分能力分析。
共有 104 名平均年龄为 25 ± 6.5 岁的患者出现心脏事件占 13.5%、产科事件占 14.42%、新生儿事件占 28.85%。单变量分析发现与纽约心脏协会功能状态、妊娠高血压疾病、剖宫产、胎龄<27 周、低氧血症和 mWHO 风险有关。多变量分析仅发现剖宫产（优势比[OR]，2.68；95%置信区间[CI]，1.05-6.86）和分娩时胎龄（OR，0.39；95%CI，0.22-0.67）与结局相关。mWHO 风险的曲线下面积为 0.75。
妊娠合并心脏病患者不良事件发生率较高。胎龄和剖宫产术是不良母婴结局的预测因素。mWHO 风险分类对不良结局有较好的预测作用。
