妊娠合并心脏病患者分娩方式及其对新生儿预后的影响

目的分析不同NYHA分级妊娠合并心脏病患者分娩方式及其对新生儿预后的影响。 方法选取2016年2月至2017年6月胶州市妇幼保健院收治的63例妊娠合并心脏病患者，根据美国纽约心脏病学会心功能分级(NYHA)分为Ⅰ～Ⅱ级组(39例)、Ⅲ～Ⅳ级组(24例)，统计不同NYHA分级心脏病类型分布情况，对比两组产妇妊娠结局(阴道分娩、剖宫产及心力衰竭发生率)、新生儿结局早产发生率、宫内发育迟缓发生率、新生儿阿氏(Apgar)评分、出生体质量]。 结果63例妊娠合并心脏病患者中，排前3位心脏病类型依次为先天性心脏病(38.10%)、心律失常(22.22%)、风湿性心脏病(15.87%)；Ⅰ～Ⅱ级组阴道分娩率23.08%高于Ⅲ～Ⅳ级组0.00%，剖宫产率76.92%低于Ⅲ～Ⅳ级组100.00%，心力衰竭发生率0.00%低于Ⅲ～Ⅳ级组20.83%(P<0.05)；Ⅰ～Ⅱ级组早产发生率、宫内发育迟缓发生率低于Ⅲ～Ⅳ级组，1 min Apgar评分、出生体质量高于Ⅲ～Ⅳ级组(P<0.05)。 结论先天性心脏病是妊娠合并心脏病的主要类型，NYHA分级与产妇妊娠结局及新生儿预后密切相关，心功能分级越高，妊娠不良事件发生风险越高。对NYHAⅠ～Ⅱ分级者可适当放宽阴道分娩指征，对Ⅲ～Ⅳ级者宜行剖宫产终止妊娠。

The delivery mode of pregnancy complicated with heart disease and its effect on the prognosis of neonates

ObjectiveTo analyze the delivery mode of pregnancy complicated with heart disease and its effect on the prognosis of neonates. MethodsSixty-three pregnant women with heart disease admitted to Jiaozhou Maternal & Child Health Hospital from February of 2016 to June of 2017 were divided into two groups according to NYHA classification, including class Ⅰ-Ⅱ group (39 cases) and class Ⅲ-Ⅳ group (24 cases). Outcomes (incidence of vaginal delivery, cesarean section and heart failure), neonatal outcomes (incidence of preterm birth, incidence of intrauterine growth retardation, Apgar score, birth weight) were compared between two groups. ResultsAmong 63 pregnant women with heart disease, the top three types of heart disease were congenital heart disease (38.10%), arrhythmia (22.22%) and rheumatic heart disease (15.87%). The vaginal delivery rate of grade Ⅰ-Ⅱ group was 23.08%, higher than that of grade Ⅲ-Ⅳ group (0.00%), and the cesarean section rate was 76.92%, lower than that of grade Ⅲ-Ⅳ group (100.00%). The incidence of heart failure was 0.00% in grade Ⅰ-Ⅱ group, lower than that of grade Ⅲ-Ⅳ group (20.83%) (P<0.05). The incidences of premature delivery and intrauterine growth retardation in grade Ⅰ-Ⅱ group were lower than those of grade Ⅲ-Ⅳ group, and the Apgar score and birth weight in 1 min were higher than those in grade Ⅲ-Ⅳ group (P<0.05). ConclusionCongenital heart disease is the main type of pregnancy with heart disease, and NYHA classification is closely related to maternal pregnancy outcomes and neonatal prognosis. The higher the heart function classification, the higher the risk of adverse pregnancy events. The indications of vaginal delivery can be relaxed appropriately for pregnancy with NYHA graders Ⅰ-Ⅱ, and cesarean section should be performed to terminate pregnancy for NYHA graders Ⅲ-Ⅳ.