Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
School of Dentistry, Amrita Institute of Medical Sciences, Kochi, India.
Acta Obstet Gynecol Scand. 2021 Apr;100(4):666-675. doi: 10.1111/aogs.14029. Epub 2020 Nov 2.
The objective of this study was to systematically review the maternal and fetal outcomes in pregnant women who underwent percutaneous balloon mitral valvuloplasty (PBMV) during pregnancy.
A search was conducted on MEDLINE and Embase databases to identify studies published between 2000 and 2018 that reported on maternal and fetal outcomes following PBMV performed in pregnancy. Randomized controlled trials, cohort studies, case-control studies, cross-sectional studies and case series with four or more pregnancies in which PBMV was performed during pregnancy were included. Reference lists from relevant articles were also hand-searched for relevant citations. A successful procedure was defined as one where there was a reported improvement in the valve area or reduction in the mitral valve gradient. A random effects model was used to derive pooled estimates of various outcomes and the final estimates were reported as percentages with a 95% confidence interval (95% CI).
Twenty-one observational studies reporting 745 pregnancies were included in the review, all of them having reported outcomes without a comparison group. Most of the studies fell into the low-risk category as determined using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. Most of the studies (86%) were reported from low- to middle-income countries and PBMV was mostly performed during the second trimester of pregnancy. Forty-three procedures (5.7%) were unsuccessful, nearly half (n = 19) of them reported among women with the severe subvalve disease (Wilkins subvalve score 3 or more). There were 11 maternal deaths among those with suboptimal valve anatomy (severe subvalve disease or Wilkin score >8). Mitral regurgitation was the most common cardiac complication (12.7%; 95% CI 7.3%-19.1%), followed by restenosis (2.4%; 95% CI 0.02%-7.2%). Pooled incidence of cesarean section was 12.1% (95% CI 3.6%-23.8%), preterm delivery 3.9% (95% CI 0.6%-9.0%), stillbirth 0.9% (95%CI 0.2%-2.2%) and low birthweight 5.4% (95% CI 0.2%-14.7%).
PBMV may be an effective and safe procedure for optimizing outcomes in pregnant women with mitral stenosis in the absence of severe subvalve disease.
本研究旨在系统回顾行经皮二尖瓣球囊成形术（PBMV）的孕妇的母婴结局。
对 MEDLINE 和 Embase 数据库进行检索，以确定 2000 年至 2018 年期间发表的报告 PBMV 在妊娠期间进行后的母婴结局的研究。纳入的研究包括随机对照试验、队列研究、病例对照研究、横断面研究和有 4 例或更多例妊娠的病例系列研究，且 PBMV 在妊娠期间进行。还对相关文章的参考文献进行了手工检索，以寻找相关引文。成功的手术定义为报告瓣膜面积增加或二尖瓣梯度降低。使用随机效应模型得出各种结局的汇总估计值，最终估计值以百分比表示，置信区间为 95%（95%CI）。
本综述纳入了 21 项观察性研究，共报告了 745 例妊娠，所有研究均报告了无对照组的结局。根据 Joanna Briggs 研究所（JBI）病例系列批判性评价检查表，大多数研究（86%）属于低风险类别。大多数研究（86%）来自中低收入国家，PBMV 主要在妊娠中期进行。43 例（5.7%）手术不成功，其中近一半（n=19）报告于严重瓣下病变（Wilkins 瓣下评分 3 或更高）患者中。有 11 例产妇死亡发生于解剖结构不理想的患者中（严重瓣下病变或 Wilkin 评分>8）。最常见的心脏并发症是二尖瓣反流（12.7%；95%CI 7.3%-19.1%），其次是再狭窄（2.4%；95%CI 0.02%-7.2%）。剖宫产的发生率为 12.1%（95%CI 3.6%-23.8%），早产率为 3.9%（95%CI 0.6%-9.0%），死胎率为 0.9%（95%CI 0.2%-2.2%），低出生体重儿发生率为 5.4%（95%CI 0.2%-14.7%）。
在没有严重瓣下病变的情况下，PBMV 可能是一种有效且安全的方法，可优化有二尖瓣狭窄的孕妇的结局。
