Department Obstetrics & Gynecology Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department Obstetrics & Gynecology Fakfak General Hospital, West Papua, Indonesia.
J Pregnancy. 2021 Sep 27;2021:3248850. doi: 10.1155/2021/3248850. eCollection 2021.
This study is aimed at evaluating the maternal and perinatal characteristics and pregnancy outcomes of ES. . This is a retrospective cohort study of pregnancy with Eisenmenger syndrome (ES) in Dr. Soetomo Hospital from January 2018 to December 2019. Total sampling size was obtained. We collected all baseline maternal-perinatal characteristic data, cardiac status, and pregnancy outcomes as primary outcomes. The maternal death cases were also evaluated, and we compared characteristics based on defect size (< or >3 cm).
During study periods, we collected 18 cases with ES from a total of 152 pregnancies with heart disease. The underlying heart disease type includes atrial septal defect (ASD), ventricle septal defect (VSD), and patent ductus arteriosus (PDA). All cases suffered pulmonary hypertension (PH), 3 cases moderate, and 15 cases as severe. 94% of cases fall into heart failure (DC FC NYHA III-IV) during treatment. The majority of cases are delivered by cesarean section (88.9%). Pregnancy complications found include preterm birth (78%), low birthweight (94%), intrauterine growth restriction (55%), oligohydramnios (16%), severe preeclampsia (33%), and placenta previa (5.5%). Large defect group has an older maternal ages (30.18 ± 4.60 vs. 24.15 ± 2.75; = 0.002), higher clinical sign (100 vs. 40%, = 0.003), and higher preterm delivery rate (100% vs. 69%, = 0.047) compared to small defect groups. The R to L or bidirectional shunt is significantly higher at the large defect group (13 vs. 5 cases, = 0.006, 95% confidence interval: -1.156 to -0.228). There were seven maternal death cases caused by shock cardiogenic.
Pregnancy with ES is still associated with very high maternal neonatal mortality and morbidity. The larger defect size is correlated with clinical performances and pregnancy outcomes. Effective preconception counseling is the best strategy to reduce the risk of maternal and neonatal death in ES women.
本研究旨在评估 ES 的孕产妇和围产期特征及妊娠结局。这是一项回顾性队列研究，纳入了 2018 年 1 月至 2019 年 12 月在苏加诺医院就诊的妊娠合并 Eisenmenger 综合征（ES）患者。采用完全抽样法。我们收集了所有基线孕产妇围生期特征数据、心功能状态和妊娠结局等主要结局。还评估了孕产妇死亡病例，并根据缺损大小（<3cm 或>3cm）进行了特征比较。
研究期间，我们从总共 152 例心脏病妊娠患者中收集了 18 例 ES 病例。基础心脏病类型包括房间隔缺损（ASD）、室间隔缺损（VSD）和动脉导管未闭（PDA）。所有病例均患有肺动脉高压（PH），3 例为中度，15 例为重度。94%的病例在治疗期间出现心力衰竭（纽约心脏协会心功能分级[NYHA]III-IV 级）。大多数病例为剖宫产分娩（88.9%）。发现的妊娠并发症包括早产（78%）、低出生体重儿（94%）、宫内生长受限（55%）、羊水过少（16%）、重度子痫前期（33%）和前置胎盘（5.5%）。大缺损组的产妇年龄较大（30.18±4.60 岁 vs. 24.15±2.75 岁；=0.002），临床表现更严重（100% vs. 40%；=0.003），早产率更高（100% vs. 69%；=0.047）。大缺损组的右向左或双向分流明显更高（13 例 vs. 5 例；=0.006，95%置信区间：-1.156 至-0.228）。有 7 例孕产妇死亡是由心源性休克引起的。
妊娠合并 ES 仍与母婴发病率和死亡率非常高相关。较大的缺损大小与临床表现和妊娠结局相关。有效的孕前咨询是降低 ES 妇女母婴死亡风险的最佳策略。
