Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
Chelsea & Westminster NHS Foundation Trust, London, UK.
BJOG. 2024 Jan;131(2):127-139. doi: 10.1111/1471-0528.17645. Epub 2023 Oct 4.
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
全球有 1%-4%的妊娠合并心脏疾病，其中以中低收入国家居多。产妇年龄增加、肥胖率、心血管合并症、子痫前期和妊娠期糖尿病的发生率均导致妊娠女性获得性心血管疾病的风险增加。此外，先天性心脏病（CHD）患者存活率的提高也导致越来越多的 CHD 女性选择妊娠。通过受孕前咨询制定的个性化护理计划，并基于国家和国际指南实施，有助于改善临床结局。然而，仍有相当一部分育龄妇女没有明显的合并症或危险因素，但在妊娠期间发生心脏病，且没有受孕前咨询的指征。心脏疾病的最极端表现是心源性休克（CS），主要的心脏病理导致心输出量不足和灌注不足，并与显著的死亡率和发病率相关。管理的关键是早期识别、干预以治疗任何潜在可逆转的基础病理，并采取支持措施，直至包括机械循环支持（MCS）。在本叙述性综述中，我们讨论了 CS 分类的最新进展，以及如何对其进行调整，以改善患有或有发生这种潜在致命疾病风险的孕妇的结局。
