患有心脏病的女性与匹配的健康对照组相比，妊娠和分娩的结局。

Outcomes of pregnancy and delivery in women with cardiac disease compared to matched healthy controls.

机构信息

Department of Obstetrics and Gynecology, Hadassah Mount Scopus Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.

Adult Congenital Heart Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.

出版信息

J Matern Fetal Neonatal Med. 2022 Dec;35(25):5821-5827. doi: 10.1080/14767058.2021.1895739. Epub 2021 Mar 7.

DOI:10.1080/14767058.2021.1895739

PMID:33678138

Abstract

OBJECTIVE

We compared pregnancy and delivery outcomes between women with cardiac disease versus matched healthy controls. The primary outcome was the frequency of unplanned cesarean delivery.

METHODS

In this single-center retrospective case-control study, women with cardiac disease were identified and matched (1:2 ratio, according to maternal age, parity, number of prior cesareans, gestational age, delivery onset and fetal presentation) to healthy controls who delivered within the same year. Outcomes were frequency of unplanned cesarean delivery, complications during pregnancy and postpartum course, intensive care unit (ICU) admissions, and length of hospitalization.

RESULTS

One hundred and twelve women with cardiac disease (exposed group, 225 deliveries) were identified and matched with 450 healthy women (controls, 2003-2014). The cohort comprised of 103 women (204 deliveries) with acquired heart disease (valve disease [ = 69], arrhythmia [ = 31], 3 with cardiomyopathy and peri/myocarditis, and 9 women (21 deliveries) with congenital heart disease. The frequency of unplanned cesarean was 14 (7.9%) for the exposed group as compared with 12 (3.4%) in controls with an odds ratio of 2.33 (95% CI = 1.0.2-5.32, = .045). This difference was accentuated in a sub-group of women with severe cardiac disease (15% vs. 4.2% in matched control group, = .028). Seventy-one (31.6%) exposed women exhibited obstetric and cardiovascular complications during pregnancy as compared with 65 (14.4%) controls, < .001. Twenty-five (13.9%) exposed women experienced postpartum complications versus 26 (7.5%) in the control group ( = .019). Maternal ICU admission occurred in 13 (7.3%) of the exposed group as compared with only 2 (0.6%) in controls ( < .001).

CONCLUSIONS

Women with a background cardiac condition, particularly those with severe disease, are at a higher risk for an unplanned cesarean delivery and other peripartum complications as compared with matched healthy controls.

摘要

目的

我们比较了患有心脏疾病的女性与匹配的健康对照组之间的妊娠和分娩结局。主要结局是计划性剖宫产的频率。

方法

在这项单中心回顾性病例对照研究中，确定了患有心脏疾病的女性，并根据产妇年龄、产次、既往剖宫产次数、孕龄、分娩开始和胎儿表现与健康对照组进行了匹配（1:2 比例）。结局包括计划性剖宫产的频率、妊娠和产后期间的并发症、重症监护病房（ICU）入院率以及住院时间。

结果

确定了 112 名患有心脏疾病的女性（暴露组，225 例分娩），并与 450 名健康女性（对照组，2003-2014 年）进行了匹配。该队列包括 103 名患有获得性心脏病的女性（瓣膜疾病[ = 69]、心律失常[ = 31]、3 名患有心肌病和围心肌炎、以及 9 名患有先天性心脏病的女性[ = 21 例分娩）。与对照组（3.4%）相比，暴露组计划性剖宫产的频率为 14 例（7.9%），优势比为 2.33（95%CI=1.0.2-5.32， = 0.045）。在患有严重心脏疾病的女性亚组中，这一差异更为明显（与匹配对照组相比，15% vs. 4.2%， = 0.028）。与对照组相比，71 名（31.6%）暴露组的女性在妊娠期间出现产科和心血管并发症，差异有统计学意义（ < .001）。25 名（13.9%）暴露组的女性在产后出现并发症，而对照组为 26 名（7.5%）（ = 0.019）。暴露组中有 13 名（7.3%）女性需要入住 ICU，而对照组仅有 2 名（0.6%）（ < .001）。