Miao Huixian, Chen Yunyan, Wang Chuan, Huang Taotao, Lin Jianhua
Department of Obstetrics and Gynecology, Affiliated Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Gynaecol Obstet. 2022 Apr;157(1):140-148. doi: 10.1002/ijgo.13708. Epub 2021 May 6.
To determine the outcomes in women with pulmonary hypertension (PH) and determine the factors related to adverse outcomes.
Data from 684 women with PH admitted to the Affiliated Renji Hospital from January 2001 to December 2020 were collected. Outcomes were compared based on the causes and severity of PH.
The overall mortality was 2.8%, decreasing from 6.6% in 2001-2005 to 1.7% in 2016-2020 (P = 0.10). Idiopathic PH had the highest mortality (35.3%) and the lowest live birth rate (82.4%). Mortality was similar between moderate and severe PH (5.3% versus 9.7%), but the live birth rate was much lower in severe PH (78.6% versus 89.9%). Hypoxemia and vaginal birth were risk factors of maternal death (odds ratio [OR] 35.28, 95% confidence interval [CI] 1.42-878.75; OR 850.86, 95% CI 5.67-127 606.74, respectively). General anesthesia was a risk factor in the univariate analysis (OR 12.07, 95% CI 3.72-39.15) but was not significant in the multivariate analysis (P = 0.16).
The mortality rate in this retrospective study was lower than that previously reported. Pregnancy is safe in mild PH but still has a high risk of complications in moderate and severe PH. Hypoxemia is a risk factor for maternal death, but cesarean section may be a protective factor.
确定肺动脉高压（PH）女性患者的预后情况，并确定与不良预后相关的因素。
收集了2001年1月至2020年12月期间入住上海交通大学医学院附属仁济医院的684例PH女性患者的数据。根据PH的病因和严重程度比较预后情况。
总体死亡率为2.8%，从2001 - 2005年的6.6%降至2016 - 2020年的1.7%（P = 0.10）。特发性PH的死亡率最高（35.3%），活产率最低（82.4%）。中度和重度PH的死亡率相似（5.3%对9.7%），但重度PH的活产率低得多（78.6%对89.9%）。低氧血症和经阴道分娩是孕产妇死亡的危险因素（优势比[OR]分别为35.28，95%置信区间[CI]为1.42 - 878.75；OR 850.86，95% CI为5.67 - 127606.74）。全身麻醉在单因素分析中是一个危险因素（OR 12.07，95% CI 3.72 - 39.15），但在多因素分析中不显著（P = 0.16）。
这项回顾性研究中的死亡率低于先前报道的死亡率。轻度PH患者妊娠是安全的，但中度和重度PH患者仍有较高的并发症风险。低氧血症是孕产妇死亡的危险因素，但剖宫产可能是一个保护因素。
