上海市1991～2010年妊娠合并心脏病死亡情况分析

目的:探讨妊娠合并心脏病孕产妇在系统保健管理中的经验和教训,为进一步降低孕产妇死亡率提供科学依据。方法:对上海市1991～2010年52例妊娠合并心脏病死亡的临床资料、死亡个案和评审结果进行回顾性分析。结果:①1991～2000年全市妊娠合并心脏病死亡占孕产妇死亡总数的7.02%,2001～2010年呈现逐步上升趋势。②妊娠合并心脏病死亡以先天性心脏病最高(15例,28.8%),其次是风湿性心脏病(7例,13.5%)、重度肺动脉高压和围产期心肌病(各6例、分别占11.5%)。③妊娠合并心脏病死亡孕产妇普遍保健意识较差,其中进行治疗、定期随访的仅17例(32.7%);8例已明确告知不宜妊娠仍坚持怀孕。④各临床科室对妊娠合并心脏病的重视度不够,全程监护评估和规范治疗欠缺。结论:提高育龄妇女的孕前和产前保健意识,对妊娠合并心脏病做到早诊断和早治疗;同时临床各科医务人员也应提高对妊娠合并心脏病的诊断和监护水平,进行孕期全程动态评估,从而改善妊娠结局。

Analysis on death status of pregnant women with heart disease in Shanghai city from 1991 to 2010

Objective:To explore the experiences of system health management for pregnant women with heart disease,provide scientific basis for further reducing maternal mortality.Methods:The clinical data,death case,and evaluation results of 52 pregnant women with heart disease in Shanghai city from 1991 to 2010 were analyzed retrospectively.Results:Among the maternal deaths,7.02% of them were found with pregnancy combined with heart disease in Shanghai city from 1991 to 2000,and the proportion showed an gradual increasing trend from 2001 to 2010.Among the pregnant women with heart disease,the proportion of pregnant women with congenital heart disease was the highest(15 cases,28.8%),followed by rheumatic heart disease(7 cases,13.5%),severe pulmonary hypertension(6 cases,11.5%),and peripartum cardiomyopathy(6 cases,11.5%).The health awareness of pregnant women with heart disease was poor,only 17 cases(32.7%) received treatment and regular follow-up;8 cases insisted pregnancy when they were informed.The clinical departments didn’t pay attention to the cases,and monitoring evaluation and regular treatment were deficient.Conclusion:To improve pregnancy outcome of pregnant women with heart disease,the prepregnant and prenatal health awareness of women at childbearing age should be improved,early diagnosis and treatment should be ensured;the diagnostic level and monitoring level of medical staff should be improved,and the dynamic evaluation for the course of pregnancy should be conducted.