Instituto Mexicano del Seguro Social, Hospital de Especialidades, Centro Medico Nacional "La Raza", Mexico City, Mexico.
Instituto Mexicano del Seguro Social, Hospital de gineco-obstetricia, Centro Medico Nacional "La Raza", Mexico City, Mexico.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5140-5148. doi: 10.1080/14767058.2021.1875433. Epub 2021 Feb 25.
Cardiac diseases complicate 4% of pregnancies, with a mortality rate between 0 and 15%. Early referral has shown to reduce the risk of maternal major cardiac events (MACEs).
We retrospectively analyzed a cohort of pregnant women with heart disease from two referral centers in Mexico City. We examined MACEs: maternal death, pulmonary edema, acute heart failure, endocarditis, stroke, myocardial infarction, acute aortic syndromes, arrhythmias requiring urgent treatment, and the need for an urgent intervention; preterm birth and obstetric events such as HELLP syndrome, preeclampsia, eclampsia, placental abruption, obstetric hemorrhage. We analyzed the association between each modified World Health Organization (mWHO) group and MACEs, preterm birth and obstetric outcomes between March 2014 and March 2019.
Using the mWHO classification, 399 deliveries were included and stratified as follows: I, 162; II, 133; II-III, 21; III, 18; and IV, 52 patients. MACEs were observed in 12.5% of the cohort and were associated with mWHO II (odds ratio [OR], 3.0; 95% confidence interval [95% CI], 1.1-8.1; = 0.027), II-III (OR, 3.3; 95% CI, 0.9-1.0; = 0.116), III (OR, 5.3; 95% CI, 1.2-23; = 0.026), and IV (OR, 8.2; 95% CI, 2.7-24.5; < 0.001) after adjusting for age, desaturation, previous functional class, and gestational age at referral. An association between mWHO and frequency of preterm birth was observed. Association between mWHO and obstetric events, even when adjusted, was not observed.
The prevalence of MACEs and preterm birth is similar to that seen worldwide; MACEs and preterm birth are associated with the severity of heart disease stratified by mWHO, but there is no association between the severity of heart disease and obstetric events.
心脏病在妊娠中的发病率为 4%，死亡率在 0 至 15%之间。早期转介可降低产妇发生重大心脏事件（MACE）的风险。
我们回顾性分析了来自墨西哥城两个转诊中心的患有心脏病的孕妇队列。我们检查了 MACE：产妇死亡、肺水肿、急性心力衰竭、心内膜炎、中风、心肌梗死、急性主动脉综合征、需要紧急治疗的心律失常以及紧急干预的需要；早产和产科事件，如 HELLP 综合征、子痫前期、子痫、胎盘早剥、产科出血。我们分析了 2014 年 3 月至 2019 年 3 月期间，每个改良世界卫生组织（mWHO）组与 MACE、早产和产科结局之间的关系。
使用 mWHO 分类，共纳入 399 例分娩，并分为以下几类：I 类 162 例；II 类 133 例；II-III 类 21 例；III 类 18 例；IV 类 52 例。该队列中观察到 12.5%的患者发生 MACE，与 mWHO II（比值比 [OR]，3.0；95%置信区间 [95%CI]，1.1-8.1；=0.027）、II-III（OR，3.3；95%CI，0.9-1.0；=0.116）、III（OR，5.3；95%CI，1.2-23；=0.026）和 IV（OR，8.2；95%CI，2.7-24.5；<0.001）类相关，校正年龄、低氧饱和度、既往功能分级和转诊时的孕龄后。mWHO 与早产频率之间存在关联。即使调整了 mWHO，也未观察到 mWHO 与产科事件之间的关联。
MACE 和早产的发生率与全球水平相似；MACE 和早产与 mWHO 分层的心脏病严重程度相关，但心脏病严重程度与产科事件无关。
