伴有房室传导阻滞的妊娠母婴结局。
Pregnancy maternal fetal outcomes among pregnancies complicated with atrioventricular block.
机构信息
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, Sichuan, China.
出版信息
BMC Pregnancy Childbirth. 2022 Apr 10;22(1):307. doi: 10.1186/s12884-022-04650-x.
BACKGROUND
Atrioventricular block (AVB) during pregnancy is rare. Case study for pregnancy with AVB have been reported but a consensus guideline for peripartum management has not been established. This study aimed to investigate cardiac and obstetric complications and outcomes in our pregnant women with AVB and share our management experience.
METHODS
This was a retrospective study. We reviewed a total of 74 pregnant women with AVB who delivered at our tertiary care center in the past 10 years. The patients were categorized into four groups according to the degree of block. The data were analyzed and compared among the four groups of patients.
RESULTS
Regarding the cardiac complications, the cardiac function level showed significant difference among patient groups. The higher NYHA class were observed in patients with higher degree AVB. Pacemaker was placed before delivery in 32/33 patients with III° AVB, 8/25 patients with II° AVB, and 0/16 patient with I° AVB. Other types of arrhythmias except AVB were present in all groups of patients but more frequently observed in type I patients with II° AVB. No other heart abnormalities were observed among the patient groups. Obstetric complications were found in 21 women (28.4%), including premature labor, premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), preeclampsia, etc. The incidence rate of fetal cardiac abnormalities was 6.58%. But no statistical difference was detected among four groups of patients for fetal and maternal complications and fetal cardiac abnormalities (P>0.05). Caesarean section was performed more in patients with high-degree AVB than in patients with low-degree AVB. No maternal or neonatal death in our cases.
CONCLUSIONS
Most women with AVB could achieve successful pregnancy and delivery. Patients with II° AVB type II and III° AVB should be monitored vigilantly during pregnancy and post-partum. Temporary pacing before delivery appeared to be beneficial for women with III°AVB, and accurate diagnosis and care by a multidisciplinary team was recommended.
背景
妊娠合并房室传导阻滞（AVB）较为罕见。虽然有报道称妊娠合并 AVB 的病例研究，但尚未建立围产期管理的共识指南。本研究旨在探讨妊娠合并 AVB 患者的心脏和产科并发症及结局，并分享我们的管理经验。
方法
这是一项回顾性研究。我们回顾了过去 10 年在我们的三级医疗中心分娩的 74 例妊娠合并 AVB 患者。根据阻滞程度将患者分为四组。分析并比较了四组患者的数据。
结果
在心脏并发症方面，各组患者的心脏功能水平存在显著差异。阻滞程度较高的患者 NYHA 心功能分级较高。33 例完全性 AVB 患者中，32 例在分娩前安置了起搏器，25 例不完全性 II 度 AVB 患者中 8 例，16 例不完全性 I 度 AVB 患者中无 1 例。除 AVB 外，各组患者均存在其他类型的心律失常，但 II 度 AVB 患者中 I 型更为常见。各组患者均未发现其他心脏异常。21 例（28.4%）患者发生产科并发症，包括早产、胎膜早破（PROM）、妊娠期糖尿病（GDM）、子痫前期等。胎儿心脏异常发生率为 6.58%。但四组患者在胎儿和产妇并发症及胎儿心脏异常方面的发生率无统计学差异（P>0.05）。高度 AVB 患者较低度 AVB 患者更倾向于行剖宫产。本研究中无产妇或新生儿死亡。
结论
大多数 AVB 患者可成功妊娠和分娩。妊娠合并 II 度 AVB 型 II 型和 III 度 AVB 患者应在妊娠和产后期间密切监测。分娩前临时起搏似乎对 III 度 AVB 患者有益，建议多学科团队进行准确诊断和护理。
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