Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Am J Perinatol. 2022 Aug;39(11):1196-1203. doi: 10.1055/s-0040-1721716. Epub 2020 Dec 22.
Guidelines do not exist to determine timing of delivery for women with cardiovascular disease (CVD) in pregnancy. The neonatal benefit of a term delivery as compared with an early term delivery is well described. We sought to examine maternal outcomes in women with CVD who delivered in the early term period (37 through 38 weeks) compared with those who delivered later.
This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal, and obstetric characteristics were evaluated.
Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of any hypertension during pregnancy (18.1 vs. 7%, = 0.01) and intrauterine growth restriction (22.9 vs. 2.8%, < 0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8 vs. 3.5%, = 0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4 vs. 24.7%, = 0.004).
There is no maternal benefit of an early term delivery in otherwise healthy women with CVD. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women.
· Question of delivery timing in women with cardiac disease.. · No difference in cardiac morbidity, term versus early term.. · Term delivery in women with asymptomatic cardiac disease..
目前尚无指南指导心血管疾病（CVD）孕妇的分娩时机。足月分娩与早产相比对新生儿有益，这一点已有明确描述。我们旨在研究在早期足月（37-38 周）分娩的 CVD 女性与晚期分娩的女性相比，其母体结局。
这是一项前瞻性队列研究，调查 2011 年 9 月至 2016 年 12 月期间分娩的 CVD 女性的心脏和产科结局。评估了分娩时的孕龄与母体、胎儿和产科特征之间的关系。
共纳入 225 例 CVD 女性，83 例（37%）在早期足月分娩，142 例（63%）在足月分娩。虽然早期足月组的妊娠期间任何高血压发生率（18.1% vs. 7%， = 0.01）和宫内生长受限发生率（22.9% vs. 2.8%， < 0.001）显著较高，但高危心脏或产科特征并无差异。复合心脏发病率也无差异（4.8% vs. 3.5%， = 0.24）。早期足月组行剖宫产的可能性高于足月组（43.4% vs. 24.7%， = 0.004）。
对于其他健康的 CVD 女性，早期足月分娩没有母体获益。鉴于早期足月分娩对胎儿的已知后果，本研究支持现有文献中关于这些女性应进行足月分娩的建议。
· 心脏病女性的分娩时机问题。· 足月与早产的心脏发病率无差异。· 无症状心脏病女性应行足月分娩。
