Georgetown University School of Medicine, Washington, DC (Ms Laird).
Division of Maternal Fetal Medicine, Department of Women's and Infant's Services, Medstar Washington Hospital Center, Washington, DC (Drs Kumnick, Fries, and Chornock).
Am J Obstet Gynecol MFM. 2024 Apr;6(4):101323. doi: 10.1016/j.ajogmf.2024.101323. Epub 2024 Mar 2.
Congenital and acquired heart disease complicate 1% to 4% of pregnancies in the United States. Beyond the risks of the underlying maternal congenital heart disease, cardiac surgery and its sequelae, such as surgical scarring resulting in higher rates of arrhythmias and implanted valves altering anticoagulation status, have potential implications that could affect gestation and delivery.
This study aimed to investigate whether history of maternal cardiac surgery is associated with adverse obstetrical or neonatal outcomes compared with patients without a history of cardiac disease or surgery, considered "healthy controls."
This is a secondary analysis of retrospective cohort studies performed at a tertiary care facility in the United States comparing obstetrical outcomes in patients with a history of open cardiac surgery who delivered from January 2007 to December 2018 with healthy controls, who delivered from April 2020 to July 2020. There were 74 pregnancies in 61 patients with a history of open cardiac surgery that were compared with pregnancies in healthy controls. Of the 74 pregnancies, 65 were successfully matched based on gestational age to controls at a 1:3 (case-to-control) ratio. The remainder of cases were matched at a 1:2 or 1:1 ratio; therefore, a total of 219 control pregnancies were included in the analysis. Our primary outcome was the incidence of hypertensive disorders of pregnancy, as well as cesarean delivery, in patients with a history of open cardiac surgery compared with healthy controls. Our secondary outcome was the incidence of low-birthweight neonates in patients with a history of open cardiac surgery compared with healthy controls.
Patients with a history of cardiac surgery were not more likely to have any hypertensive disorder diagnosed than healthy controls. Patients with a history of cardiac surgery were more likely to have an operative delivery (P<.0001) but equally likely to have a cesarean delivery (P=.528) compared with healthy controls. Birthweight was not statistically different of 2655±808 g in neonates born to patients with a history of cardiac surgery vs 2844±830 g born to healthy controls (P=.092).
Patients with a history of cardiac surgery may not be at higher risk of hypertensive disorder diagnosis during pregnancy. Similarly, most patients with a history of cardiac surgery are also likely not at higher risk of cesarean delivery or low-birthweight neonates.
在美国，先天性和后天性心脏病使 1%至 4%的妊娠复杂化。除了母体先天性心脏病、心脏手术及其后遗症（如手术疤痕导致心律失常发生率更高，植入瓣膜改变抗凝状态）的风险之外，这些风险可能会影响妊娠和分娩。
本研究旨在调查与无心脏病或手术史的“健康对照组”患者相比，有母亲心脏手术史的患者是否与不良产科或新生儿结局相关。
这是在美国一家三级保健机构进行的回顾性队列研究的二次分析，比较了 2007 年 1 月至 2018 年期间有开胸心脏手术史的患者与 2020 年 4 月至 2020 年 7 月期间健康对照组的产科结局。有 61 例有开胸心脏手术史的患者中有 74 例妊娠，与健康对照组的妊娠进行比较。在 74 例妊娠中，根据胎龄成功匹配了 65 例对照组，比例为 1:3（病例对照）。其余病例以 1:2 或 1:1 的比例匹配；因此，共有 219 例对照组妊娠纳入分析。我们的主要结局是与健康对照组相比，有开胸心脏手术史的患者妊娠高血压疾病和剖宫产的发生率。我们的次要结局是与健康对照组相比，有开胸心脏手术史的患者低出生体重儿的发生率。
有心脏手术史的患者与健康对照组相比，被诊断为高血压疾病的可能性没有增加。有心脏手术史的患者更有可能接受手术分娩（P<.0001），但与健康对照组相比，行剖宫产的可能性相同（P=.528）。出生体重在有心脏手术史的新生儿中为 2655±808g，在健康对照组新生儿中为 2844±830g，差异无统计学意义（P=.092）。
有心脏手术史的患者在妊娠期间可能不会有更高的高血压疾病诊断风险。同样，大多数有心脏手术史的患者也不太可能有更高的剖宫产或低出生体重儿的风险。
