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。     

妊娠合并先天性心脏病伴肺动脉高压患者的母婴结局

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母婴结局.方法:对2005年12月至2009年9月在四川大学华西第二医院产科诊治的21例妊娠合并先心痛伴肺动脉高压患者的临床资料进行回顾性分析,根据肺动脉收缩压分为轻度组(35～54 mmHg)4例、中度组(55～74 mmHg)6例和重度组(≥75 mmHg)11例,比较各组心脏病种类、心功能级别、终止妊娠的孕周和方式以及母婴结局.结果:①先心痛以房间隔缺损(房缺)和室间隔缺损(室缺)为主,均分别占38.1%(8/21),有2例(9.5%,2/21)为室缺合并房缺,2例(9.5%,2/21)动脉导管未闭,1例完全性肺静脉异位引流(心内型),其中轻、中度组以房缺为主(70.0%,7/10);重度组以室缺为主(72.7%,8/11).②轻、中度组心功能以Ⅰ～Ⅱ级为主,轻度组有1例心功能Ⅲ级,中度组有2例心功能Ⅲ级,均无心力衰竭发生,孕产妇结局良好;而重度组心功能Ⅲ～Ⅳ级达90.9%(10/11),有3例产前或产后出现早期心力衰竭表现或发生心力衰竭,1例死亡.③分娩方式以剖宫产为主,占95.2%(20/21);轻、中度组均足月分娩,重度组足月产3例,早产6例;④中度组有1例足月低体重儿并发新生儿轻度窒息;重度组有3例足月低体重儿,6例早产儿,各组均无新生儿死亡;重度组死胎2例.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,母婴妊娠结局越差;剖宫产终止妊娠是较安全的分娩方式.     

妊娠合并心脏病伴肺动脉高压85例的围生结局

目的:探讨妊娠合并心脏病伴肺动脉高压患者的母婴结局.方法:回顾性分析2004年1月至2012年10月,泰山医学院附属医院和泰安市中心医院产科收治的妊娠合并心脏病伴肺动脉高压85例患者的临床资料.根据肺动脉压力情况分为轻度组50例(30 ～49 mmHg),中重度组35例(≥50 mmHg),分析两组终止妊娠孕周和方式以及母婴结局.结果:①入院时,轻度组4个级别的心功能所占的比例与中重度组比较,差异均有统计学意义(P ＜0.05,P＜0.01);治疗后(出院时)与治疗前相比,轻度组和中重度组心功能Ⅰ级的患者明显增多(P＜0.05),心功能为Ⅱ级的患者减少(P＜0.05),而Ⅲ级和Ⅳ级与治疗前比较差异无统计学意义(P＞0.05).②轻度组阴道分娩率和分娩孕周均高于中重度组(P＜0.05),而轻度组医源性流产、心力衰竭和孕产妇死亡率低于中重度组(P＜0.05).③轻度组新生儿平均出生体重高于中重度组(P＜0.05),轻度组早产儿和新生儿窒息所占比例均低于中重度组(P＜0.05).结论:妊娠合并肺动脉高压患者压力越高,孕妇心功能衰竭、剖宫产率和早产率随之增加,围生儿低体重、胎儿丢失率和新生儿窒息率明显增加;经积极救治,患者心功能情况有所好转,主要是心功能为Ⅱ级的患者;手术终止妊娠是比较安全的分娩方式,肺动脉压力为轻度时,在条件允许的情况下可行阴道试产.     

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。     

妊娠合并心脏病伴肺动脉高压患者的妊娠结局

目的 探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局。方法 收集1996年1月至2004年8月间,我院产科收治的61例妊娠合并心脏病伴肺动脉高压患者的临床资料（其中先天性心脏病36例,风湿性心脏病21例,心律失常1例,原发性肺动脉高压性心脏病2例,系统性红斑狼疮性心脏病1例）,根据肺动脉压力情况分为轻度组32例[30-49mmHg（1mmHg=0．133kPa）],中度组23例（50～79mmHg）,重度组6例（t〉80mmHg）,分析各组心脏病种类、心功能级别、终止妊娠孕周和方式以及母儿结局。结果 （1）轻度组心功能Ⅰ-Ⅱ级者23例,中度组心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级的发病例数分别为9、5、5、4例,重度组心功能Ⅲ-Ⅳ级者5例。（2）风湿性心脏病患者中,中、重度肺动脉高压者11例,占52％（11／21）;发生严重心功能衰竭者9例,占43％（9／21）,先天性心脏病患者中,以轻、中度肺动脉高压者为主（97％,35／36）,且以心功能Ⅰ-Ⅱ级者为主（81％,29／36）。（3）轻度组足月妊娠24例,新生儿平均体重为2744g;中度组足月分娩11例,早产8例,医源性流产4例;重度组足月分娩1例,早产3例,医源性流产2例。各组围产儿疾病发生率比较,差异无统计学意义（P〉0．05）。（4）妊娠合并心脏病伴肺动脉高压者的分娩方式以刮宫产分娩为主,占79％（48／61）。（5）孕产妇死亡率为2％（1／61）,医源性胎儿丢失率为13％（8／61例）。结论 随着肺动脉压力的升高,孕妇心功能衰竭的发生率随之增加,围产儿疾病发生率和胎儿丢失率也明显增加;妊娠合并风湿性心脏病患者中、重度肺动脉高压的发生率高于先天性心脏病患者;手术终止妊娠是比较安全的分娩方式。     

妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响

目的探讨妊娠合并风湿性心脏病患者心功能状态对妊娠结局的影响。方法对1993年1月至2006年7月在我院产科分娩的、资料齐全的65例妊娠合并风湿性心脏病患者的临床资料进行回顾性分析。根据患者的二尖瓣狭窄程度分为二尖瓣正常组20例（瓣口面积〉4．0cm^2）、轻度狭窄组11例（瓣口面积2．5—4．0cm^2）、中度狭窄组14例（瓣121面积1．5—2．5cm^2）以及重度狭窄组20例（瓣口面积〈1．5cm^2）;根据是否伴有肺动脉高压分为正常压力组33例[肺动脉压〈30mmHg（1mmHg=0．133kPa）]、轻度升高组18例（肺动脉压31—49mmHg）、中度升高组7例（肺动脉压50～79mmHg）和重度升高组7例（肺动脉压≥80mmHg）;根据孕前是否进行心脏手术分为心脏手术组14例和非心脏手术组51例;根据患者的不同心功能状态分为Ⅰ级组24例、Ⅱ级组13例、Ⅲ级组13例、Ⅳ级组15例,观察各组的围产儿结局。分析以上各种因素对妊娠合并风湿性心脏病患者妊娠结局的影响。结果（1）二尖瓣正常组患者心功能Ⅰ～Ⅱ级者为80％（16／20）,Ⅳ级组患者中,80％（12／15）在中度狭窄组（6例）及重度狭窄组（6例）,与二尖瓣正常组和轻度狭窄组的心功能Ⅳ级发生率（20％,3／15）比较,差异有统计学意义（P〈0．05）。（2）正常压力组患者心功能Ⅰ～Ⅱ级者为73％（24／33）,重度升高组患者心功能Ⅳ级的发生率（6／7）明显高于心功能Ⅰ级的发生率（1／7）,两者比较,差异有统计学意义（P〈0．05）。（3）心脏手术组患者心功能Ⅰ～Ⅱ级发生率为71％（10／14）,Ⅲ级和Ⅳ级的发生率均为14％（2／14）,前后两者比较,差异有统计学意义（P〈0．05）;非心脏手术组患者Ⅰ～Ⅳ级心功能发生率之间分别比较,差异均无统计学意义（P〉0．05）。（4）心功能Ⅰ～Ⅲ级组患者的平均孕周及新生儿平均出生体重分别比较,差异无统计学意义（P〉0．05）;而心功能Ⅳ级组平均孕周为（34．6±3．1）周,新生儿平均出生体重为（2176±186）g,明显低于心功能Ⅰ级组,两组比较,差异有统计学意义（P〈0．05）。心功能Ⅲ～Ⅳ级组患者中,共发生医源性流产和引产9例（14％,9／65）,医源性早产18例（28％,18／65）,胎儿生长受限4例（6％,4／65）,围产儿死亡3例（5％,3／65）;而心功能Ⅰ～Ⅱ级组患者以上指标均为0。（5）65例妊娠合并风湿性心脏病患者中合并心房纤颤者7例,其心功能Ⅲ～Ⅳ级（心功能衰竭）的发生率为6／7。结论妊娠合并风湿性心脏病患者伴中、重度二尖瓣狭窄、重度肺动脉压升高及心房纤颤,容易发生心功能衰竭危及生命,不宜妊娠。已妊娠者应尽早终止妊娠;心功能Ⅲ～Ⅳ级的妊娠合并风湿性心脏病患者的医源性流产、早产和围产儿病率均增加,围产儿结局不良。     

妊娠合并肺动脉高压36例临床分析

目的:探讨妊娠合并肺动脉高压(PAH)患者的临床情况。方法:回顾分析2011年1月至2017年6月南京医科大学第一附属医院产科收治的36例妊娠合并PAH患者的临床资料,根据肺动脉压力情况分为轻度组8例(30～49mmHg),中度组12例(50～79mmHg),重度组16例(≥80mmHg),分析病情及妊娠结局。结果:轻度组心功能Ⅰ～Ⅱ级占87.5%(7/8),中度组心功能Ⅱ～Ⅲ级占66.7%(8/12),重度组Ⅲ～Ⅳ级占62.5%(10/16)。随着肺动脉压升高,心功能分级随之上升,差异比较有统计学意义(P0.05)。36例妊娠合并PAH患者中,主要原因为先天性心脏病(50%,18/36)。重度组孕产妇合并症、住院时间、死亡率均高于轻中度组(P0.05),重度组的新生儿窒息率、医源性流产率亦高于轻中度组(P0.05)。孕产妇死亡3例(7.2%,3/36),均为重度PAH(18.8%,3/16),心功能均为Ⅳ级,其中2例术中死亡,1例产后死亡。结论:妊娠合并PAH患者的妊娠结局不容乐观,孕前应综合评估。肺动脉压力越高,孕妇心功能衰竭、剖宫产率和死亡率随之增加,医源性流产及新生儿窒息率亦随之增加。手术终止妊娠为较安全的分娩方式。     

妊娠合并肺动脉高压10例临床分析

目的:分析妊娠合并肺动脉高压(PH)的临床特点,探讨其妊娠分娩时机及围生期监测治疗措施.方法:回顾性分析我院2005年6月至2009年1月10例妊娠合并PH患者的临床资料.结果:原发性肺动脉高压(PPH)1例,继发性肺动脉高压(SPH)9例(风湿性心脏病4例、先天性心脏病5例);轻度PH 3例,中度PH 6例,重度PH 1例;心功能Ⅰ～Ⅱ级4例.心功能Ⅲ～Ⅳ级6例;足月分娩4例,早产5例,早孕人工流产1例;剖宫产8例,阴道分娩1例;产妇死亡1例,极低出生体重儿2例,新生儿死亡1例.结论:PPH患者应避免妊娠,SPH患者依心功能、肺动脉压力高低决定是否妊娠,最好在手术或药物治疗后妊娠.中、重度PH患者妊娠后建议早期终止妊娠,中晚期妊娠患者以剖宫产终止妊娠为宜.产妇和新生儿的预后取决于多种因素的影响.     

妊娠合并肺动脉高压18例临床分析

目的:探讨妊娠合并肺动脉高压患者的妊娠结局.方法:对1992～2009年在我院产科诊治的妊娠合并肺动脉高压18例患者的临床资料进行回顾性分析.结果:18例患者轻度肺动脉高压8例,中度肺动脉高压5例,重度肺动脉高压5例.围生儿死亡2例,孕产妇死亡2例,医源性引产1例,其余均在分娩后,心功能经改善后出院.结论:妊娠时,随着肺动脉压力的增加,孕产妇和围生儿的预后渐差,如果妊娠合并肺动脉高压合并艾森曼格综合征,则孕产妇预后更差.妊娠期间应尽可能维持心功能Ⅰ～Ⅱ级.手术终止妊娠是比较安全的分娩方式,麻醉以硬膜外麻醉为宜.     

妊娠合并先天性心脏病伴肺动脉高压79例妊娠结局分析

目的分析妊娠合并先天性心脏病伴肺动脉高乐患者的妊娠结局。方法回顾性分析2009年1月至2013年6月北京安贞医院妇产科收治的79例妊娠合并先天性心脏病伴肺动脉高压患者的临床资料,根据肺动脉压力将其分为轻度组、中度组、重度组。分析各组先天性心脏病种类、心功能级别、终止妊娠的方式以及母婴结局。结果先心病类型以房间隔缺损（房缺）和室间隔缺损（室缺）为主,肺动脉高压轻度组心功能以Ⅰ～Ⅱ级为主,重度组心功能以Ⅲ～Ⅳ级为主。79例患者中,行医源性流产者16例（20．8％）,经阴道分娩5例（6．5％）,剖宫产56例（72．7％）。重度组医源性流产率高于其他组,足月分娩率低于其他组,差异有统计学意义（P〈0．05）。新生儿早产20例（32．8％）,足月产41例（67．2％）,死产1例,随着肺动脉压力的增加,早产的发生率增加,三组之间相互比较差异有统计学意义（P〈0．05）。结论肺动脉高压患者应在妇产科及心脏科医师指导下妊娠,不宜妊娠者应及早终止妊娠。孕产妇终止妊娠方式以剖宫产为主,麻醉方式以硬膜外麻醉为宜。     

Pregnancy outcomes in women with heart disease

Aim

To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country.

Methods

A retrospective analysis was carried out of 144 pregnancies in women with cardiac disease who delivered in our unit between 1997 and 2006. Perinatal and maternal outcomes were interpreted according to the type of the heart disease and status of the patient according to the New York Heart Association (NYHA) classification.

Results

The rates of rheumatic and congenital heart disease were 87.5 and 12.5%, respectively. The distribution of the patients according to the NYHA functional classification were 55.6, 36.1 and 8.3% for NYHA classes I, II and III–IV, respectively. There was no maternal mortality. Maternal morbidity was observed in 16 (11.1%) cases. Six perinatal mortalities (4.2%) occurred in this series. There were no significant difference in birth weight, gestational age at delivery and perinatal morbidity between the NYHA stage I–II and stage III–IV groups (P > 0.05), whereas maternal morbidity and cesarean delivery rates were significantly higher in the NYHA stage III–IV group (P < 0.001).

Conclusion

Rheumatic heart disease with pregnancy is still predominant in Turkey. Most of the patients were in a good functional group. Maternal morbidity strongly correlates with maternal cardiac classification.     

Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study

Objective: To assess prospectively the maternal cardiovascular hemodynamic changes and obstetric outcome in women with rheumatic heart disease (RHD) and to detect predictors of poor outcome.

Methods: This prospective observational study included 204 pregnant patients with RHD who were divided into two groups; successful pregnancy group with living fetus (n?=?126) and poor obstetric outcome group with fetal or neonatal loss (n?=?78). Hemodynamic changes, maternal and fetal outcome were assessed and recorded.

Results: There was a highly significant difference between the two groups regarding disease criteria with more women suffering from stenotic lesions (mitral and aortic), pulmonary hypertension, previous heart failure, receiving cardiac medications and higher NYHA class (III and IV) in the poor obstetric outcome group (p?p?Conclusions: Increased maternal age and body mass index together with NYHA class III–IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.     

Pregnancy duration and mode of delivery in patients with cardiac insufficiency on the material of Jagiellonian University OB/GYN Clinic in the years between 1986-1999

OBJECTIVES: Recent progress in cardiology and cardiac surgery lead many patients with cardiac disease in the procreative age. DESIGN: To asses the influence of cardiac disease on pregnancy and delivery. MATERIAL AND METHODS: 232 subjects with congenital and acquired cardiac anomalies, hospitalized in the Jagiellonian University OB/GYN Clinic between 1986-1999. Patients were divided according to NYHA classification depending on kind and grade of cardiovascular insufficiency. Acquired data were compared with data in the control group consisted of 424 subjects without any complications during pregnancy and delivery. RESULTS: We proved shortening of the pregnancy duration in more advanced NYHA classes. Percentage shave of preterm deliveries in 3rd and 4th class was 31.15%, what equals to 3 times preterm delivery rate in the control group. Preterm delivery rate in groups of NYHA I and II was similar to the rate in the control group. Acquired data reveal extremely high cesarean section rate in the material of patients with cardiac anomalies. Cesarean section rate in the group of NYHA I and II was 3 times higher (30%) than in control group (rate of 10%). NYHA III and IV groups has a cesarean section rate of 93%. Vaginal delivery rate in the NYHA I and II groups equals to 58.5%, what is 10 times higher than in NYHA III and IV groups (equals to 6.6%). CONCLUSIONS: 1. Pregnancy duration depends on cardiovascular sufficiency and is significantly shorten in NYHA III and IV groups. 2. Extremely high cesarean section rate in the analyzed group is due to decreased cardiac sufficiency.     

正常妊娠妇女及妊娠期糖尿病患者胰岛素和C肽水平的变化

目的 探讨正常妊娠妇女、妊娠期糖尿病（ＧＤＭ）及妊娠合并糖耐量减低（ＧＩＧＴ０患者孕期胰岛素、Ｃ肽水平的变化,了解其胰岛β细胞的功能状况。方法 用放射免疫法测定ＧＤＭ患者４８例（Ⅰ组）;ＧＩＧＴ患者３９例（Ⅱ组）;正常妊娠妇女４２例（Ⅲ组）;正常非妊娠妇女２２例（Ⅳ组）的胰岛素和Ｃ肽水平。结果 Ⅲ组孕晚期的胰岛素、Ｃ肽水平明显高于Ⅳ组（Ｐ均〈０．０１）,且从孕３４周至孕晚期,有上升趋势,至产时呈高     

Pregnancy outcome in women with pulmonary arterial hypertension: single-center experience from India

Background

A retrospective analysis of the records of all the patients of pulmonary arterial hypertension with pregnancy at AIIMS, New Delhi, India, to study maternal and perinatal outcome and to compare outcome between severe and mild pulmonary arterial hypertension.

Materials and methods

A retrospective analysis was carried out of 30 pregnancies in women with pulmonary arterial hypertension (PAH) who delivered at ≥28 weeks of gestation from July 2006 through July 2012 at a tertiary care center in India. Pulmonary artery blood pressure (PABP) during the first trimester of pregnancy or before pregnancy was considered to define PABP as severe or mild, with severe cases having systolic PABP >50 mmHg on echocardiography.

Results

Out of 30 patients, 14 patients had severe PAH and 16 patients had mild PAH. Women with severe PAH had a significantly higher incidence of preterm delivery (11 vs. 3, P < 0.05), small for gestational age infants (10 vs. 2, P < 0.05) and cardiac complications (6 vs. 1, P < 0.05) compared to women with mild PAH. There was maternal mortality in a patient with Eisenmenger syndrome. In women with severe PAH and mild PAH, PABP increased in later pregnancy from 63.14 ± 7.6 to 71.57 ± 7.9 mmHg (P < 0.05) and from 40.37 ± 3.6 to 41.69 ± 4.1 mmHg (P < 0.05), respectively.

Conclusions

Pregnancy in women with severe PAH is associated with higher maternal morbidity and adverse fetal outcome compared to pregnancy in women with mild PAH.