上海市15年妊娠合并心脏病的临床资料分析

目的：探讨妊娠合并心脏病的变化趋势。方法：对上海市１０所教学医院１９８１～１９９５年住院分娩的妊娠合并心脏病患者的临床资料进行回顾性分析。结果：３７９０６５例分娩中，合并心脏病２６８０例，发病率为０．７１％；死亡１５例，病死率为０．５６％，死亡专率为３．９６／１０万，占孕产妇总死亡数的１２．４０％。将１５年分为１９８１～１９８５年、１９８６～１９９０年、１９９１～１９９５年３个时期观察，心脏病孕妇的死亡率分别占总死亡数的４．４８％、２２．８６％及２１．０５％。先天性心脏病孕妇１３３３例，占４９．７４％；风湿性心脏病孕妇７５９例，占２８．３２％，前者与后者之比为１．７６１，从３个时期的资料来看，二者的比例分别为１．２７１，２．３７１及２．８１１。心功能Ⅰ级与Ⅱ级者共占妊娠合并心脏病患者总数的８５．４５％，发生心力衰竭者为７．６０％。妊娠合并心脏病的围产儿死亡率为７．７６‰。分娩方式常采用剖宫产。结论：妊娠合并心脏病至今仍是孕产妇死亡的主要原因之一。应建立孕前咨询中心，根据其心脏病种类及分型、心功能状况进行评分，以判定该患者能否妊娠。     

妊高征性心脏病35例临床分析

目的 探讨防治妊高征性心脏病的有效方法,减少并发症,降低孕产妇和围生儿病死率。方法 采用回顾性分析方法对35例妊高征性心脏病进行分析。结果 妊高征性心脏病发生率为0．39％,占同期妊高征的3．64％。孕产妇病死率0．22‰,占妊高征的首位。围生儿病死率为114．29‰。结论 加强孕期保健,对妊高征做到早诊断、早治疗,适时终止妊娠,以降低并发症。     

胸廓畸形合并妊娠138例分析

分析了１９５３年１月至１９７９年１２月、１９８０年１月至１９８５年５月，１９８５年６月至１９９４年１２月４２年间收治的胸廓畸形合并妊娠１３８例，其患病率分别为０．４２‰、０．１３１‰和０．７７‰。３组骨盆异常占８０％以上。结核与外伤是胸廓畸形的主要病因。并发症在第一、二组中肺活量减退者明显高于第三组，第一组呼吸道感染发生率明显低于第二、三组，但其肺源性心脏病发病率明显升高。３组剖宫产率分别为５２．４６％、９７．７８％、９６．９６％；围产儿死亡率分别为８．３３％、４．３４％、６．０６％；围产妇死亡率分别为３．３３％、２．２２％和０。定期随诊胸廓畸形合并妊娠孕妇的肺、心功能，预防心衰，适时行剖宫产术终止妊娠，对改善胸廓畸形合并妊娠的母婴预后有积极意义。     

妊娠合并心脏病10年临床分析

目的 探讨妊娠合并心脏病的１０年变化及产科处理。方法 采用回顾性分析方法对妊娠合并心脏病１６５例临床资料进行分析。结果 将１０年分为两个阶段来观察，妊娠合并心脏病的发病率为１．１９％，其中先心病１０６例，占６４．２％；风心病４８例，占２９．１％。两者之比前阶段１．６３：１，后阶段２．９５：１。心脏病手术后病例亦逐年增加。心功能Ⅰ～Ⅱ级者共１４３例，占８６．７％，分娩方式以阴道分娩为主；Ⅲ～Ⅳ级行剖     

妊高征并发腹水23例分析

自１９８１年１月至１９９２年４月共处理妊高征并发腹水２３例，发生率占妊高征总例数的１．９‰（２３／１２０７７），占重度妊高征的２１．６‰（２３／１０６４）。其临床特点为发病早，无产前系统检查者２０例，在妊娠２９．４±４．８周发生妊高征，在妊娠３２．４±７．４周发生腹水。系统检查并经治疗并发腹水者３例。ＩＵＧＲ发生率为８６９％（２０／２３）。本组围产儿因引产、早产ＩＵＧＲ，死亡率达４２．１％。化验检查，腹水性质除１例为乳糜样腹水外，其余均为漏出液。肝功能谷丙转氨酶＞３０ＩＵ者（酶法），占１７０％；尿素氮＞６．４ｍｍｏｌ／Ｌ者，占２１．０％；血浆白蛋白＜３．５ｇ／Ｌ者，占９５．７％；血白蛋白／球蛋白比值均＜１．５。一旦并发腹水应及时终止妊娠，分娩后腹水可消退。     

妊娠合并心脏病的处理

妊娠合并心脏病的处理６３００４２重庆医科大学附属第一医院简丽，吴味辛妊娠合并心脏病是孕产妇死亡的四大原因之一，国内报告的病死率为１．９５～２．２５％。患心脏病孕妇的胎儿亦较正常孕妇的胎儿预后差，尤其是发生心力衰竭或紫绀型先心的孕妇，由于缺氧可发生胎儿...     

妊娠合并急性肾功能衰竭21例诊治体会

急性肾功能衰竭（ＡＲＦ）是妊娠妇女的重要合并症之一，也是导致母儿死亡的重要原因。近１０多年来，妊娠合并ＡＲＦ的发生率已明显下降，预后亦明显改善。本文总结了我院近２０年来２１例妊娠合并ＡＲＦ的临床资料，对其致病因素、分布情况及防治进行探讨。１　临床资料１－１　一般资料　统计本院１９７８年至１９９８年住院的妊娠者６５４７６例，符合急性肾功能衰竭（ＡＲＦ）诊断标准［１］的患者有２１例，发生率为０－３２‰，同期全院ＡＲＦ的病例共３２５例，与妊娠有关者占６－４％，死亡４例，病死率为１９－０４％，２１例ＡＲ…     

摩洛哥塔扎省4年孕产妇死亡原因分析

目的 了解摩洛哥塔扎省孕产妇的死亡原因，以降低孕产妇死亡率。方法 对1999年1月～2002年12月孕产妇死亡病例资料进行回顾性分析。结果 4年中孕产妇死亡31例，死亡率为96．12／10万，15例在家中分娩，占48．39％，28例从未做过产前检查，占90．32％，只有3例有不正规检查几次，3胎以上24例，占77．42％，最多11胎。孕产妇死亡的重要原因依次为产科出血、产褥感染、子宫破裂、妊娠合并心脏病、梗阻性难产，也有死于妊娠期急性阑尾炎、肝脏疾病及肺部疾病等原因者。结论 塔扎地区必须宣传计划生育，落实避孕措施，开展孕产期保健工作，建立孕产期系统保健的分级管理制度以及转诊系统管理制度，筛选高危妊娠，提高住院分娩率，加强对基层产科工作者的能力培训，提高业务水平，才能降低孕产妇死亡率。     

全国孕产妇死亡监测结果分析

对１９８９～１９９１年全国３０省、自治区、直辖市２４７个监测点１．０亿人口范围内的孕产妇死亡监测资料进行分析。监测地区三年内活产总数４２０１４５７例，孕产妇死亡３２７４例，孕产妇监测死亡率平均为８０．０／１０万，调整后为８７．８／１０万。城市、农村、不同地区孕产妇死亡率的高低有明显差异，三年比较，城市、农村孕产妇死亡率呈下降趋势，农村更为明显。孕产妇死亡原因主要为产科出血、好高征、心脏病、产褥感染、羊水栓塞、肝病，产科出血主要原因为胎盘滞留、宫缩乏力。结果显示：可避免的死亡占８９．０％，不可避免的死亡占１１．０％。并对孕产妇死亡的有关问题进行讨论。     

早期异位妊娠 B 超误诊8例分析

早期异位妊娠Ｂ超误诊８例分析陶静西①邓西平②异位妊娠是妇产科常见的急腹症之一，其发生率占妊娠的０．５％～１％，近年来有上升趋势。现将我院手术证实为异位妊娠，而Ｂ超诊断为宫腔内妊娠的８例患者作回顾性分析。一、临床资料自１９９５年１月至１９９６年６月住院...     

Maternal and perinatal outcome of pregnancies complicated by cardiac disease.

OBJECTIVE: The aim of this study was to assess the maternal and perinatal outcome of pregnancies complicated by cardiac disease in a tertiary care center in Egypt. METHODS: During a 1-year period, a total of 86 pregnant women with cardiac disease were admitted. Maternal and perinatal morbidity and mortality were calculated and compared with a control group. RESULTS: Seventy-seven (89.5%) patients were due to rheumatic affection, and 60 patients were classified as NYHA classes I-II. There was one case of maternal mortality (1.16%), and 10 other cases developed life-threatening complications. Two perinatal mortalities (2.32%) occurred in this series. Birth weight of babies born to mothers with functional classes III and IV were significantly lower than those of functional classes I-II and control group. CONCLUSION: Rheumatic heart disease with pregnancy is still predominant in Egypt. Maternal and perinatal morbidity and mortality are strongly correlated to maternal cardiac functional classification.     

妊娠合并肺动脉高压妊娠结局分析

目的分析妊娠合并肺动脉高压(PH)临床特点,探讨其围生期监护及妊娠终止时机、方式。方法收集福建医科大学附属第一医院2005年1月至2011年4月37例妊娠合并PH患者的临床资料,根据肺动脉压力情况分为轻度组19例[30～<50mmHg(1mmHg=0.133kPa)],中度组10例(50～<80mmHg),重度组8例(≥80mmHg)。分析心脏病情况及母婴结局。结果 (1)37例肺动脉高压患者中,风湿性心脏病18例,先天性心脏病11例,围生期心肌病5例,肥厚型心肌病1例,特发性肺动脉高压1例,未发现心脏器质性改变1例。(2)轻度组心功能Ⅰ～Ⅱ级占68.4%(13/19)。中度组心功能Ⅱ～Ⅲ级占70%(7/10)。重度组心功能Ⅲ～Ⅳ级占75%(6/8)。(3)32例患者(86.5%)行剖宫产术。1例轻度肺动脉高压孕妇经阴道分娩。1例产妇死亡(2.7%)。4例中期引产(12.1%)。7例早产,新生儿窒息3例,低出生体重儿4例,新生儿死亡1例。结论妊娠合并肺动脉高压属于高危妊娠,随着肺动脉压力升高心功能衰竭的发生率增加,围生儿疾病发生率和胎儿丢失率也明显增加,母儿预后取决于孕期是否伴有合并症。晚期妊娠患者以剖宫产终止妊娠为宜。     

Maternal periodontal disease and perinatal mortality

Background: Periodontal disease has been associated with increased perinatal mortality.
Aims: To examine the association between maternal periodontal disease and perinatal mortality.
Methods: We performed a retrospective and prospective matched case–control study of women with unexplained perinatal mortality at more than 20 weeks gestational age. Women were matched for socioeconomic status, smoking status and time since delivery. All women underwent a detailed periodontal examination and completed a questionnaire describing oral health symptoms. No intervention took place.
Results: Fifty-three women who had experienced a perinatal death and 111 controls completed the study. Thirty-two women were recruited retrospectively and 21 women were recruited prospectively. Twenty-three (43.4%) women who had experienced a perinatal death and 27 (24.3%) controls had periodontal disease. There were no differences in oral health behaviours or symptoms between cases and controls. Perinatal death was associated with periodontal disease (odds ratio (OR) 2.34, 95% confidence interval (CI) 1.05, 5.47). Periodontal disease was more strongly associated with perinatal mortality due to extreme prematurity (OR 3.60, 95% CI 1.20, 12.04). Multivariate analysis showed this relationship to be consistent after inclusion of higher parity, country of birth, advanced maternal age and maternal obesity in the model (OR 4.56, 95% CI 1.25, 21.27).
Conclusions: Maternal periodontal disease may contribute to perinatal mortality, especially that caused by extreme prematurity.     

妊娠合并先天性心脏病伴肺动脉高压患者的围产结局分析

目的 探讨妊娠合并先天性心脏病（先心病）伴肺动脉高压患者的围产结局。方法 收集1995年4月至2007年5月温州医学院附属第一医院产科收治的45例妊娠合并先心病伴肺动脉高压患者的临床资料,根据肺动脉压力情况分为轻度组29例[30～49mmHg（1mmHg=0．133kPa）],中度组8例（50～79mmHg）,重度组8例（≥80mmHg）,分析各组先心病的种类、心功能级别、终止妊娠孕周和方式、先心病术后妊娠的安全性以及围产结局。结果 （1）先心病种类中以房间隔缺损、室间隔缺损为主,发生率为58％（26／45）。孕前行心脏矫正手术13例（29％,13／45）,以轻度肺动脉高压、心功能Ⅰ～Ⅱ级为主。（2）轻度组心功能Ⅰ～Ⅱ级者28例,中度组心功能Ⅰ～Ⅱ级者6例,重度组心功能Ⅲ～Ⅳ级者7例。（3）轻度组足月分娩27例、难免流产1例、早产1例,新生儿平均出生体重为（3153±399）g;中度组足月分娩5例,早产3例;重度组足月分娩5例,医源性终止妊娠1例,早产2例;中、重度组新生儿平均出生体重明显低于轻度组,差异有统计学意义（P〈0．05）,同时中、重度组胎儿结局不良。（4）妊娠合并先心病伴肺动脉高压患者的分娩方式以剖宫产分娩为主,占78％（35／45）,其中轻度组剖宫产分娩22例（22／29）,中度组6例（6／8）,重度组7例（7／8）。（5）45例患者中有11例于孕前或产后出现心功能衰竭早期表现或心功能衰竭,均分布在中、重度组,且心功能均为Ⅲ～Ⅳ级。其中2例死亡。结论 妊娠合并先心病伴肺动脉高压患者的肺动脉压力越高,围产结局越差;孕前行心脏矫正手术后的先心病患者以轻度肺动脉高压为主,且围产结局良好;以剖宫产术终止妊娠是比较安全的分娩方式。     

Obstructive sleep apnea in pregnancy and fetal outcome.

OBJECTIVE: To simultaneously investigate the polysomnography (PSG) and nonstress test (NST) records of pregnant women with obstructive sleep apnea (OSA) to observe NST changes during maternal desaturation and determine maternal and fetal outcomes. METHODS: A prospective observational study of pregnant women assessed by questionnaire for symptoms of OSA. Women with self-reported frequent snoring or apnea were offered PSG and NST. RESULT: OSA was diagnosed in 4 (11.4%) of the 35 pregnant women who underwent PSG. Three (75%) had fetal heart decelerations accompanying maternal desaturation. The neonates of women diagnosed with OSA had lower mean Apgar scores and birth weights compared with neonates of women without OSA. Three neonates from the women diagnosed with OSA were admitted to the newborn healthcare unit. CONCLUSION: OSA in pregnancy has important maternal and fetal outcomes. Pregnant women should be assessed for symptoms of OSA and suspected cases should be offered PSG.     

Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.     

Pregnancy outcome in women with heart disease undergoing induction of labour

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.     

妊娠合并心脏病266例临床分析

探讨妊娠合燕心脏病患者不同心功能状态对母亲和围产儿的影响。方法对我国院１９９３年１月至１９９９年３月间、２６６例妊娠合并心脏病患者的临床资料进行回顾性分析。结果（１）妊娠合并心脏病患者以心肌炎、心肌炎后遗症及不明原因性心律失常的发生率最高（１７９例,６７．２９％）,其次为先天性心脏病（４１例,１５．４１％）,其发生率高于风湿性心脏病（２８例,１０．９１％）。（２）风湿性心脏病的先天性心脏病是导致心     

Pregnancy in sickle cell disease in Bahrain.

OBJECTIVE: To review the maternal and fetal complications in pregnant women with sickle cell disease and to compare their pregnancy outcome with those of controls. DESIGN: A case-control study. SETTING: Ministry of Health hospitals in Bahrain. SUBJECTS: 147 pregnancies in 140 women with sickle cell disease and 294 controls matched for age and parity. MAIN OUTCOME MEASURES: The characteristics of women who had crises, the frequency of the crises, hypertensive disorders of pregnancy, infection, diabetes, perinatal mortality and the delivery statistics in the index and control women. RESULTS: Maternal mortality was 1.4% and perinatal mortality was 73.3/1000 total births in women with sickle cell disease, there were no maternal deaths and the perinatal mortality was 6.8/1000 births in the control group. Anaemia was treated by blood transfusion in 47% of women with sickle cell disease and, of these, 39% had a crisis that appeared to have been precipitated by the transfusion in the absence of any other predisposing factors. The presence of raised HbF did not decrease the number of crises but reduced their severity. CONCLUSION: Pregnancy in women with sickle cell disease should be monitored very closely as it constitutes a high risk to both the mother and the baby.     

新疆维、汉族重度子痫前期孕妇器官受累特点与围产儿预后的关系

目的:探讨新疆维吾尔族与汉族重度子痫前期孕妇器官受累特点及其与围产儿预后的关系。方法:回顾性分析297例重度子痫前期患者的临床资料。将重度子痫前期患者按民族分为维族和汉族。分析比较2组患者的一般临床数据、器官受累和并发症发生情况及围产儿结局。结果:297例重度子痫前期患者中,119例存在器官受损,维、汉两族患者均以单器官损害为主,维族患者器官损害以胎盘和肾脏损害为主,汉族则以胎盘、心脏和视网膜损害为主。两脏器受损患者中,汉族以胎盘并子痫及胎盘并DIC为主,维族以胎盘并肾损害为主。多器官受损患者中,维、汉族无明显差异。器官受损维族患者的围产儿死亡率较汉族高,差异有统计学意义。多因素Logistic回归分析,胎儿及新生儿死亡与孕妇器官受损的数量有关,两器官和多器官受损的胎儿及新生儿死亡率高于单器官受累者,且以维族患者明显。结论:重度子痫前期的器官受损在维族和汉族之间有明显的不同,个体及民族之间的多因素和多基因可能决定着不同的病理机制。