Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2183349. doi: 10.1080/14767058.2023.2183349.
Pulmonary arterial hypertension (PAH) increases the risk for perinatal women and newborns, especially in women with congenital heart disease (CHD). We explored the maternal, perinatal, and postneonatal outcomes of PAH in pregnant women with CHD in China.
A total of 95 pregnant women with CHD-PAH in Beijing Anzhen Hospital from 2009 to 2013 were included retrospectively. We described their characteristics and examined the associations between the grade of PAH and maternal, perinatal, and postneonatal outcomes.
The New York Heart Association (NYHA) classification grade, delivery mode, and infant outcomes in CHD-PAH patients were analyzed. Overall 95 patients with CHD-PAH, there were 17 patients in mild group(17.7%), 27 patients in moderate group (28.1%), and 51 patients in severe group (53.1%)。The CHD patients with mild PAH, were mostly NYHA class I-II and CHD patients with severe PAH were NYHA class II-IVs. Cesarean section (67.7%) was the most common method of delivery. The rate of therapeutic abortion in the severe group (76.9%) was obviously higher than that in other groups (11.5% in mild group and moderate group respectively), whereas there was no term delivery in severe group, with 2 cases in mild group and moderated group respectively . The rates of heart failure and therapeutic abortion in pregnant women were positively associated with the severity of PAH. The rate of term delivery was higher in patients whose CHD had been corrected by cardiac surgery (83.3%) before pregnancy.
Patients with severe PAH have poor cardiac adaptability, poor maternal and fetal outcomes, and are contraindicated during pregnancy. Patients with mild PAH are not absolutely contraindicated during pregnancy, but their heart burden increases significantly in the third trimester. Patients in mid-gestation should preferentially be delivered by cesarean section. When pregnant patients prefer to continue pregnancy, their close monitoring is essential. We provide useful data for guiding management of pregnancy and delivery in patients with CHD in China.
肺动脉高压（PAH）增加了围产期妇女和新生儿的风险，尤其是患有先天性心脏病（CHD）的女性。我们探讨了中国患有 CHD 的孕妇中 PAH 的母婴、围产儿和新生儿结局。
回顾性纳入 2009 年至 2013 年在北京安贞医院的 95 例 CHD-PAH 孕妇。我们描述了她们的特征，并检查了 PAH 分级与母婴、围产儿和新生儿结局之间的关系。
分析了 CHD-PAH 患者的纽约心脏协会（NYHA）分级、分娩方式和婴儿结局。共有 95 例 CHD-PAH 患者，轻度组 17 例（17.7%），中度组 27 例（28.1%），重度组 51 例（53.1%）。轻度 PAH 的 CHD 患者多为 NYHA Ⅰ-Ⅱ级，重度 PAH 的 CHD 患者多为 NYHA Ⅱ-Ⅳ级。剖宫产（67.7%）是最常见的分娩方式。重度组（76.9%）的终止妊娠率明显高于其他组（轻度组和中度组分别为 11.5%），而重度组没有足月分娩，轻度组和中度组各有 2 例。孕妇心力衰竭和终止妊娠的发生率与 PAH 的严重程度呈正相关。妊娠前经心脏手术矫正的 CHD 患者的足月分娩率（83.3%）较高。
重度 PAH 患者心脏适应性差，母婴和胎儿结局差，孕期禁忌。轻度 PAH 患者并非绝对禁忌，但在妊娠晚期心脏负担明显增加。中孕期患者应优先剖宫产分娩。当妊娠患者希望继续妊娠时，需要密切监测。我们为指导中国 CHD 患者的妊娠和分娩管理提供了有用的数据。
