Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy.
Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada.
Can J Cardiol. 2023 Aug;39(8):1067-1077. doi: 10.1016/j.cjca.2023.04.010. Epub 2023 Apr 20.
Pericardial effusion is the most common manifestation of pericardial diseases during pregnancy. This effusion is benign, mild, or moderate, well tolerated, with spontaneous resolution after delivery; no specific treatment is required. Acute pericarditis is the second most common condition, usually requiring medical therapy during pregnancy. Cardiac tamponade and constrictive pericarditis are rare in pregnancy. Pre-pregnancy counselling is essential in women of childbearing age with recurrent pericarditis to plan pregnancy in a phase of disease quiescence and to review therapy. High-dose aspirin or nonselective nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can be used up to the 20th week of gestation. Low-dose prednisone (2.5-10 mg/d) can be administered throughout pregnancy. All of these medications, apart from high-dose aspirin, may be used during lactation. Colchicine is compatible with pregnancy and breastfeeding, and it can be continued throughout pregnancy to prevent recurrences. Appropriate follow-up with a multidisciplinary team with experience in the field is recommended throughout pregnancy to ensure good maternal and fetal outcomes.
心包积液是妊娠期间最常见的心包疾病表现。这种积液是良性的、轻度或中度的,能够很好地耐受,分娩后会自行消退;不需要特定的治疗。急性心包炎是第二常见的情况,通常在妊娠期间需要药物治疗。妊娠时心脏压塞和缩窄性心包炎罕见。对于有复发性心包炎的育龄妇女,应在疾病静止期进行妊娠前咨询,并复习治疗方案。在妊娠 20 周之前,可以使用大剂量阿司匹林或非选择性非甾体抗炎药(如布洛芬和吲哚美辛)。低剂量泼尼松(2.5-10mg/d)可在整个孕期使用。除了大剂量阿司匹林之外,所有这些药物都可在哺乳期使用。秋水仙碱与妊娠和哺乳兼容,可在整个孕期使用以预防复发。建议整个孕期都由有该领域经验的多学科团队进行适当的随访,以确保母婴良好结局。