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[合并预激综合征的妊娠对妊娠结局的影响]

[Pregnancy with pre-excitation syndrome influence on pregnancy outcomes].

作者信息

Luo L M, Xu N, Sun L P, Xu D, Yang D, Zhang J

机构信息

Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Department of Clinical Medicine, Capital Medical University, Beijing 100029, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2020 Oct 25;55(10):685-690. doi: 10.3760/cma.j.cn112141-20200425-00354.

Abstract

To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes. (1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all >0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all <0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; =0.051). No pregnant woman had an arrhythmia during delivery. SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.

摘要

探讨预激综合征合并妊娠的特点及其对妊娠结局的影响。对2008年1月至2008年12月在北京安贞医院就诊的62例预激综合征合并妊娠患者的临床资料进行回顾性分析。根据孕期是否发生室上性心动过速(SVT)将其分为两组。孕期发生SVT发作组16例孕妇,未发生SVT发作组46例孕妇,采用多学科综合诊疗模式。运用SPSS软件进行数据分析,比较新生儿的孕周、年龄和体重,进而比较妊娠结局。(1)研究期间北京安贞医院分娩总数为21786例,妊娠合并预激综合征患者占0.28%(62/21786)。(2)共有44例患者(71%,44/62)在妊娠前被诊断为预激综合征,18例患者(29%,18/62)在孕期首次被诊断。在妊娠前被诊断为预激综合征的患者中,16例患者(36%,16/44)在妊娠前有发作,28例患者(64%,28/44)在妊娠前无症状,其中4例无症状患者在孕期发生SVT。(3)孕期发生SVT发作组的16例孕妇中,2例(2/16)在孕早期发生SVT发作,5例(5/16)在孕中期发生SVT发作,9例(9/16)在孕晚期发生SVT发作。在SVT发作组中,8例患者(8/16)在妊娠前有SVT发作,8例患者(8/16)在妊娠前无SVT发作。孕期未发生SVT发作组有46例患者,其中9例患者在妊娠前有SVT发作,37例患者在妊娠前无SVT发作。(4)与SVT发作组孕妇相比,两组孕妇的年龄、孕期体重增加量、分娩孕周、新生儿体重以及第一、第二产程时间差异均无统计学意义(均>0.05)。然而,SVT发作组孕期总产程较短且孕前体重较低(均<0.05)。发生SVT发作的孕妇剖宫产率为12/16,未发生SVT的孕妇剖宫产率为50%(23/46;P=0.051)。分娩期间无孕妇发生心律失常。患者孕期SVT发作多发生在孕晚期。妊娠前无症状的患者孕期也可能发生SVT。孕期发生SVT发作的预激综合征患者不良妊娠结局增加。多学科综合管理可有效控制预激综合征孕妇,有效降低孕期严重心律失常风险事件的发生,使多数患者获得良好的妊娠结局。

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