Choi Eun-Young, Kim Eun Sun, Kim Jung-Yoon, Song Min-Kyung, Kim Seong-Ho, Noh Chung Il
Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea.
Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea.
Cardiovasc Diagn Ther. 2021 Feb;11(1):81-90. doi: 10.21037/cdt-20-786.
In women, pregnancy is a period of relatively drastic hemodynamic change in a short period of time. Most pregnant women adapt well to these gradual hemodynamic changes. However, in women with congenital heart disease or other structural heart disease, adaptation to theses sudden hemodynamic changes is difficult, and heart failure or arrhythmia can get aggravated. This study shares our experiences on the outcomes of pregnancy in patients with structural heart disease.
From January 2007 to December 2016, we reviewed the medical records of all pregnant women with structural heart disease who received obstetric care at the Sejong General Hospital.
During the study period, 103 pregnancies were observed in 79 women with structural heart disease. Of the 103 pregnancies, 55 were primiparous and 48 were multiparous. Echocardiography performed before pregnancy revealed that 52 patients had moderate to severe valvular regurgitation and 38 patients had moderate to severe valvular stenosis; 22 patients had mechanical valves and 5 patients had pulmonary hypertension. Overall, there were 9 maternal cardiac events, 7 obstetric events and 19 neonatal events. Pulmonary embolic events occurred only in 1 case; 77 deliveries were made, and 26 pregnancies did not last. Among 77 deliveries, 55 patients delivered by cesarean section (C/S) (71.43%). C/S in 16 of 55 patients was performed due to the maternal hemodynamic risk.
Overall complications associated with pregnancy in women with structural heart disease were very high at 28.16%. However, it is hoped that maternal and neonatal outcomes will be improved through careful observation and preparedness for anticipated complications.
对女性而言，孕期是短时间内血流动力学发生相对剧烈变化的时期。大多数孕妇能很好地适应这些逐渐发生的血流动力学变化。然而，对于患有先天性心脏病或其他结构性心脏病的女性来说，适应这些突然的血流动力学变化很困难，心力衰竭或心律失常可能会加重。本研究分享了我们关于结构性心脏病患者妊娠结局的经验。
2007年1月至2016年12月，我们回顾了在世宗总医院接受产科护理的所有患有结构性心脏病的孕妇的病历。
在研究期间，79名患有结构性心脏病的女性共观察到103次妊娠。在这103次妊娠中，55次为初产，48次为经产。妊娠前进行的超声心动图检查显示，52例患者有中重度瓣膜反流，38例患者有中重度瓣膜狭窄；22例患者有机械瓣膜，5例患者有肺动脉高压。总体而言，有9例孕产妇心脏事件、7例产科事件和19例新生儿事件。肺栓塞事件仅发生1例；共分娩77例，26次妊娠未足月。在77例分娩中，55例患者通过剖宫产（C/S）分娩（71.43%）。55例患者中有16例因孕产妇血流动力学风险而行剖宫产。
结构性心脏病女性妊娠相关的总体并发症非常高，为28.16%。然而，希望通过仔细观察和对预期并发症的准备，改善孕产妇和新生儿结局。
