Campanharo Felipe Favorette, Araujo Júnior Edward, Born Daniel, Callado Gustavo Yano, Santana Eduardo Félix Martins, Sun Sue Yazaki, Mattar Rosiane
Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil.
Department of Cardiology, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil.
Diagnostics (Basel). 2025 Jun 16;15(12):1524. doi: 10.3390/diagnostics15121524.
The maternal mortality ratio is one of the global health indicators, and cardiopathies are the leading indirect causes of maternal deaths. Proper management of pregnant women with heart disease is crucial, as the severity of these conditions can lead to complications during the perinatal period. This study aimed to evaluate the rate of severe maternal morbidity and associated factors in pregnant women with heart disease. A retrospective cohort study was conducted at a referral hospital in São Paulo from 2008 to 2017, including pregnant women with heart disease who underwent procedures in the obstetric center ( = 345). Sociodemographic, obstetric, and pre-existing conditions were analyzed, along with life-threatening conditions, near-miss events, and maternal deaths. Heart diseases were classified according to the World Health Organization (WHO) guidelines, and health indicators were calculated using WHO-recommended formulas. The Chi-square test or Likelihood Ratio test ( < 0.05) was used to compare severe maternal morbidity among women with heart disease. The mean age of participants was 29.1 ± 7.29 years; most were white (58.8%), had completed high school (37.9%), and were married (71.6%). The most frequent pre-existing conditions were hypertension (9.6%) and diabetes mellitus (9.3%). The mean gestational age at admission/delivery was 37 weeks. According to the WHO classification, most women were classified as "II/III" (31.6%). Life-threatening conditions included hemorrhagic complications (13.9%), hypertensive complications (5.8%), clinical complications (19.7%), and severe management conditions (31.6%). Near-miss events occurred in 6.4% of patients, with clinical criteria in 2.9%, laboratory criteria in 4.3%, and management criteria in 3.5%. The cesarean section rate was 51%. Patients classified as WHO III and IV presented more severe management conditions ( < 0.0001), and those in WHO IV had a higher occurrence of near-miss events ( = 0.0001). Maternal mortality was 0.9% ( = 3). The incidence of severe maternal morbidity was 25 cases (22 near-miss events + 3 maternal deaths), equivalent to 2.86 per 1000 live births, and was significantly associated with WHO classifications III and IV.
孕产妇死亡率是全球卫生指标之一，心脏病是孕产妇死亡的主要间接原因。对患有心脏病的孕妇进行妥善管理至关重要，因为这些病症的严重程度可能导致围产期出现并发症。本研究旨在评估患有心脏病的孕妇发生严重孕产妇发病的比率及相关因素。2008年至2017年在圣保罗的一家转诊医院进行了一项回顾性队列研究，纳入在产科中心接受手术的患有心脏病的孕妇（n = 345）。分析了社会人口统计学、产科和既往病症，以及危及生命的情况、接近死亡事件和孕产妇死亡情况。根据世界卫生组织（WHO）指南对心脏病进行分类，并使用WHO推荐的公式计算健康指标。采用卡方检验或似然比检验（P < 0.05）比较患有心脏病的女性中严重孕产妇发病情况。参与者的平均年龄为29.1±7.29岁；大多数为白人（58.8%），完成高中学业（37.9%），已婚（71.6%）。最常见的既往病症是高血压（9.6%）和糖尿病（9.3%）。入院/分娩时的平均孕周为37周。根据WHO分类，大多数女性被归类为“II/III”（31.6%）。危及生命的情况包括出血并发症（13.9%）、高血压并发症（5.8%）、临床并发症（19.7%）和严重管理情况（31.6%）。6.4%的患者发生了接近死亡事件，其中临床标准占2.9%，实验室标准占4.3%，管理标准占3.5%。剖宫产率为51%。被归类为WHO III和IV的患者出现更严重的管理情况（P < 0.0001），而WHO IV的患者发生接近死亡事件的发生率更高（P = 0.0001）。孕产妇死亡率为0.9%（n = 3）。严重孕产妇发病的发生率为25例（22例接近死亡事件 + 3例孕产妇死亡），相当于每1000例活产中有2.86例，并且与WHO分类III和IV显著相关。
